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THE FACTORIES BILL
211
Door 1937.
THE LANCET LONDON : .S’9.TZTRDY, JANUARY 23, 1937
THE FACTORIES BILL THE
long-promised
Factories Bill will be laid
before Parliament during the early weeks of the session which has just opened. Even that, maybe, is not quite certain, and until the Bill is printed no one outside the departments concerned can do more than guess at the nature of its provisions. But speculation is not without a guide ; we may presume that the new Bill will be based upon the provisions of the Bills of 1924 and 1926, which failed to reach the Statute Book. We must not expect any proposals for widespread or profound alterations in factory legislation ; but we shall at least find one great boon, namely, a serious and a consistent attempt to simplify and to codify the existing Acts, regulations, and orders in which our present factory legislation is embodied -should we say, entombed ? The present confusion in the written word breeds trouble, uncertainty, and irritation both in industry itself and in its medical supervision. On the analogy of previous Bills we are also entitled to predict a
concerted effort to raise, and to define at a higher level, some of the basic minima to which a healthy factory must conform. There is an appalling gap between the daily routine of progressive firms and that of competitors who regard as lawful anything that does not actually violate any existing order or regulation. So long as this state of affairs endures, both enlightened employers and wellorganised groups of workers are placed at a serious economic disadvantage. We should like to think that the hours of work in unregulated and casual occupations will be brought under control; that overtime will be abolished for all young persons and without exception; and that some limit will be set to the overtime-employment both of men and women in industry. In his annual report for 1935 the chief inspector of factories related, as he had often done before, the serious effects of excessive overtime ; every doctor who has practised in an industrial area has railed against this evil. It is perhaps not unreasonable also to hope that minimal standards will be laid down for many, if not for most, of the basic factors in good industrial hygiene-viz., heating, lighting, and ventilation-and that welfare problems will receive the attention they require. Our own profession will the scan anxiously steps proposed to improve and develop the medical and nursing services in
industry. Our readers would do well to obtain two communications which have reached us. The first is entitled The Provisional Programme of the Factories Bill Campaign 1 ; the second, issued by the Open 1 32, Primrose Hill-road, London, N.W.3.
Council,2 is simply called The Factories
Bill
The former contains a reasoned series of suggestions which it hopes to find embodied within the new Bill; the latter argues cogently for a modern and scientific measure which will give equal and equally good conditions of work to men and to women workers. While they are at it might not these bodies of active citizens also give some attention to the Workmen’s Compensation Acts which are in a comparable state of chaos ?1
MIXED BACTERIAL MENINGITIS infections of the meninges are Thus among 442 cases of meningitis in which organisms were identified TRIPOLIs found only 2 examples : both were fatal, and in both of them Haemophilu8 influenzae (Pfeiffer’s bacillus) was isolated-once with a staphylococcus and once with a pneumococcus. In the same series there were 221 cases of meningococcal meningitis with a fatality-rate of 65 per cent., and 22 cases of streptococcal meningitis with a fatality-rate of 92 per cent. CADHAMwrites that the proportion of deaths in the latter condition is " apparently 97 per cent." and quotes H. GRAY who was able to find only 66 recorded cases of recovery, in 6 of which the patient had scarlet fever. Though streptococci may, no doubt, reach the meninges via the blood stream or through the perineural sheaths of the olfactory nerves, they usually come from the middle ear or (less often) from the nasal sinuses. In the case he reports on p. 198 Dr. CuNNINGHAM regarded the streptococci as secondary invaders-a finding he considers usual--and his opinion that the left mastoid was their source can scarcely be disputed, since organisms of the same serological type were isolated first from the mastoid antrum and later from the cerebro-spinal fluid. In this case it is clear that although drainage and intensive antimeningococcal serotherapy might have prevailed against the meningococcus alone, the advent of the haemolytic streptococcus-against which " antistreptococcus serum appears to be of little or no value "-made the outlook virtually hopeless. The fatal issue was in any event determined by the streptococcus, but it is interesting, in passing, to note that Dr. CuNNINGHAM employed meningococcal antitoxin, the value of which is not yet established ; whereas most clinicians would probably have preferred antibacterial meningococcal serum, especially now that the Lister Institute issues a special serum for use in infections by Group II, the strain usually found in the basal meningitis of infants. CUNNINGHAM rightly emphasises the importance of a complete bacteriological examination of the cerebro-spinal fluid, obtained DOUBLE
uncommon.
with rigid aseptic precautions, whenever acute mastoiditis is accompanied by signs of meningitis, and before any operation is attempted. If the meningitis is purely meningococcal, conservative measures, he believes, will suffice for the treatment 2
4,3 Iddesleigh House, Caxton-street, London, S.W.1. Tripoli, C. J. (1936) J. Amer. med. Ass. 106, 171. 4 Cadham, F. T.: Canad. med. Ass. J. December, 1936, p. 648.
Door 1937.
THE LANCET LONDON : .S’9.TZTRDY, JANUARY 23, 1937
THE FACTORIES BILL THE
long-promised
Factories Bill will be laid
before Parliament during the early weeks of the session which has just opened. Even that, maybe, is not quite certain, and until the Bill is printed no one outside the departments concerned can do more than guess at the nature of its provisions. But speculation is not without a guide ; we may presume that the new Bill will be based upon the provisions of the Bills of 1924 and 1926, which failed to reach the Statute Book. We must not expect any proposals for widespread or profound alterations in factory legislation ; but we shall at least find one great boon, namely, a serious and a consistent attempt to simplify and to codify the existing Acts, regulations, and orders in which our present factory legislation is embodied -should we say, entombed ? The present confusion in the written word breeds trouble, uncertainty, and irritation both in industry itself and in its medical supervision. On the analogy of previous Bills we are also entitled to predict a
concerted effort to raise, and to define at a higher level, some of the basic minima to which a healthy factory must conform. There is an appalling gap between the daily routine of progressive firms and that of competitors who regard as lawful anything that does not actually violate any existing order or regulation. So long as this state of affairs endures, both enlightened employers and wellorganised groups of workers are placed at a serious economic disadvantage. We should like to think that the hours of work in unregulated and casual occupations will be brought under control; that overtime will be abolished for all young persons and without exception; and that some limit will be set to the overtime-employment both of men and women in industry. In his annual report for 1935 the chief inspector of factories related, as he had often done before, the serious effects of excessive overtime ; every doctor who has practised in an industrial area has railed against this evil. It is perhaps not unreasonable also to hope that minimal standards will be laid down for many, if not for most, of the basic factors in good industrial hygiene-viz., heating, lighting, and ventilation-and that welfare problems will receive the attention they require. Our own profession will the scan anxiously steps proposed to improve and develop the medical and nursing services in
industry. Our readers would do well to obtain two communications which have reached us. The first is entitled The Provisional Programme of the Factories Bill Campaign 1 ; the second, issued by the Open 1 32, Primrose Hill-road, London, N.W.3.
Council,2 is simply called The Factories
Bill
The former contains a reasoned series of suggestions which it hopes to find embodied within the new Bill; the latter argues cogently for a modern and scientific measure which will give equal and equally good conditions of work to men and to women workers. While they are at it might not these bodies of active citizens also give some attention to the Workmen’s Compensation Acts which are in a comparable state of chaos ?1
MIXED BACTERIAL MENINGITIS infections of the meninges are Thus among 442 cases of meningitis in which organisms were identified TRIPOLIs found only 2 examples : both were fatal, and in both of them Haemophilu8 influenzae (Pfeiffer’s bacillus) was isolated-once with a staphylococcus and once with a pneumococcus. In the same series there were 221 cases of meningococcal meningitis with a fatality-rate of 65 per cent., and 22 cases of streptococcal meningitis with a fatality-rate of 92 per cent. CADHAMwrites that the proportion of deaths in the latter condition is " apparently 97 per cent." and quotes H. GRAY who was able to find only 66 recorded cases of recovery, in 6 of which the patient had scarlet fever. Though streptococci may, no doubt, reach the meninges via the blood stream or through the perineural sheaths of the olfactory nerves, they usually come from the middle ear or (less often) from the nasal sinuses. In the case he reports on p. 198 Dr. CuNNINGHAM regarded the streptococci as secondary invaders-a finding he considers usual--and his opinion that the left mastoid was their source can scarcely be disputed, since organisms of the same serological type were isolated first from the mastoid antrum and later from the cerebro-spinal fluid. In this case it is clear that although drainage and intensive antimeningococcal serotherapy might have prevailed against the meningococcus alone, the advent of the haemolytic streptococcus-against which " antistreptococcus serum appears to be of little or no value "-made the outlook virtually hopeless. The fatal issue was in any event determined by the streptococcus, but it is interesting, in passing, to note that Dr. CuNNINGHAM employed meningococcal antitoxin, the value of which is not yet established ; whereas most clinicians would probably have preferred antibacterial meningococcal serum, especially now that the Lister Institute issues a special serum for use in infections by Group II, the strain usually found in the basal meningitis of infants. CUNNINGHAM rightly emphasises the importance of a complete bacteriological examination of the cerebro-spinal fluid, obtained DOUBLE
uncommon.
with rigid aseptic precautions, whenever acute mastoiditis is accompanied by signs of meningitis, and before any operation is attempted. If the meningitis is purely meningococcal, conservative measures, he believes, will suffice for the treatment 2
4,3 Iddesleigh House, Caxton-street, London, S.W.1. Tripoli, C. J. (1936) J. Amer. med. Ass. 106, 171. 4 Cadham, F. T.: Canad. med. Ass. J. December, 1936, p. 648.