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The health of London in 1926
1927.
PUBLIC
Four reports on cancer have been issued; artificial light treatment has been kept under observation, and a word of caution as to its indiscriminate use is given. Port Sanitary Control calls for little comment. The health of the merchant seaman still remains under the care of the Board of Trade, despite the fact that its complete transference to the Ministry of Health is lo.ng overdue. A future W o r l d Health Service is not so impracticable as it appears at first sight.. Already the League of Nations Health Organisation has done much to establish a liaison between hygienists of all countries. Interchange visits of medical officers and investigation of disease continue unabated, and the International Sanitary Conference held in Paris has strengthened the general quarantine arrangements in most countries. No change is announced in the somewhat casual and obsolete methods of quarantine applied in British Ports. Sir George Newman's final summary for the year under review is direct, emphatic and encouraging. The medical officer of health is implored not to become customary or routine in thought, action or outlook, but to develop a thirst for knowledge and to possess foresight, a sound historical sense, and a high purpose. Without these latter characteristics he is scarcely earning his public pay. Even now, there is a great national awakening to the importance and value of preventive medicine; but there must be no slackening of effort, for much remains to be done. It is a matter of human endeavour.
The Health of London in 1926. R. F. N. K A Y M E N Z I E S ' annual report the y e a r 1926 provides abundant material for the study of statistical epidemiology, but a report upon the health of the Metropolis must necessarily be large, and it is not possible to refer more than briefly to several sections which are of particular interest. A somewhat serious view is taken of the progressive spread of small-pox in the Midland and Northern Counties in recent years. The number of cases occurring outside London has increased from 973 in 1922 to 10,141 in 1926, whilst the Metropolitan area has remained comparatively free from the disease. The high proportion of the un-
D for
HEALTH. vaccinated section of the population gives rise to some apprehension when consideration is given to the fact that it is hardly reasonable to assume that London will retain its immunity indefinitely. It is satisfactory to note that tim slow, but steady, decline in the mortality rate of tuberculosis, which has been recorded in recent years, has been maintained. A disturbing feature in connection with what might otherwise be termed a profitable phase of public health work, is the remarkable increase in the mortality from phthisis among y o u n g adults, especially among y o u n g women, during the past ten years. This increase is not only relative, but actual. T h e explanation offered is that women entered into business pursuits during the W a r , and, in the course of time, they have displaced men in certain occupations and thus have reduced their husbands' earning capacity. The death rate from cancer shows a further slight advance. Dr. Menzies points out, however, that much of the increase shown in the annual rates, since the beginning of this century does not represent actual increase in the incidence of the disease, but is the result of the increased proportion of persons of higher age in the London population, which has in recent years been further accentuated by the rapid decrease in the birth-rate. The statistics given in the section of the report relating to rheumatism in childhood justify the efforts which are being made by local authorities to stem the ravages of this condition. Whereas in 1919, 20'5 per cent of the chronic invalidity in London school children was due to tuberculosis, and 14"5 per cent was due to rheumatism, in 1926 only 12 per cent was due to tuberculosis and 24 per cent to rheumatism. This remarkable change is due not to an increase in the latter disease, but to the fact that administrative measures have diminished the former. Practically onethird of the children recommended for admission to physically defective schools in London during 1926 were suffering from noncongenital heart disease. These figures illustrate the importance of the unit of 60 beds established for rheumatic children at Queen Mary's Hospital, Carshalton, in November, 1926. It is to be hoped that, as the result of the experience to be gained at Queen M a r y ' s Hospital and the other Metropolitan Asylums Board institutions where additional rheumatism beds are to be provided, local authorities
6
PUBLIC HEALTH.
will recognise that rheumatic fever calls for their immediate attention. Out-door education for London children is provided at five open-air schools for nontuberculous children accommodating 1,070 pupils, five open-air schools for tuberculous children with 365 pupils, five country camp schools accommodating 484 children for short periods and providing for about 4,700 children annually, and 137 open-air classes in connection with ordinary open-air schools providing for children between the ages of two and five years. By the year 1929, four additional open-air schools for non-tuberculous children will have been established. Dr. Menzies reports that the efforts of the County Council in this direction have been attended with very good results, and judging from " after-care " reports the expenditure of money on these schools is proving a wise investment. Of a group of 200 children who attended one of the schools, not one had had a return of his original affection, and all but four are settled in useful occupations. It is interesting to note the circumstances which led to. the establishment of a hospital ~lass for children suffering from lupus vulgaris. Several years ago there were, in the Light Department of the London Hospital, about twenty children undergoing treatment for this disease. All were unfit for school owing to the extent and severity of the disease ; some had not attended for several years. There were, amongst them, children from different parts of the country, who had come especially to London for treatmept, and these were boarded o u t . T h e y were not receiving education, and were without the benefits of school teaching and social supervision. As a result of representations by the medical officer in charge of the Light Department, a school was opened in April, 19:25. T o fit in with the arrangements for treatment at the London Hospital, the girls attend in the forenoon, and the boys in the afternoon. The educational attainments of the children vary owing to the different ages, and the lorig periods of absence from school. H a n d w o r k enters largely into the curriculum. The school is performing very necessary work, and its vaiue cannot be measured by the small number of pupils. This report covers the first twelve months of Dr. Menzies' service as County Medical Officer, and is a worthy successor to the splendid series of reports from the pen of Sir William Hamer.
Oc'ro~z~,
Hygiene in the Mercantile Marine. H I S is to beg that all into whose hands
this number of PUBLIC HEALTH comes will T read the presidential address of Dr. HowardJones, of Newport, to the Services Group of the Society on " H y g i e n e in the Mercantile Marine " ; to b e g that having savoured the sense of national and professional shame that that reading must engender they will not conceal its existence. W h a t Dr. Howard-Jones has to say with regard to the conditions that even to-day exist on English ships, so far as accommodation for the crews is concerned, should be known throughout the land. Also it should be known that so far as requirements b y the Government are concerned, while in other lands--Australia, for example, and Norway and Sweden--these are definite, and it is insisted that real attention shall be given to the hygiene of the quarters provided for the crew so that a reasonable amount of sanitary comfort and decency may be assured, here in the country that even the most sophisticated believes to have been the cradle of seamanship and to be the mistress of the seas, and the youngest knows to be immeasurably deep in the debt of seamen, the department responsible - - t h e Board of Trade--demands, in effect, nothing. Offering only a suggestion here and there to the owner, it accepts and approves as satisfactory , arrangements that the Australian, the Norwegian and the Swedish shipbuilder discards as vile, if by chance an English vessel comes into his possession. Dr. Howard-Jones submits his facts almost too dispassionately, but perhaps the very bareness of his statements makes the situation all the more pitiable ; fills, and must fill, everyone who reads them with a desire to. do everything possible to secure something better for men who, apparently asking for little, deserve so much. Medical Officers of Health of Ports, so this paper reveals, have been trying for years to obtain improvements. Apparently little or no effect has been produced so far as the Board of Trade is concerned. They need help, the help of every medical officer of health in the country, and of all others that each one of these can rouse. Dr. Howard-Jones does not, in words, appeal for that help; yet the appeal is there. W h e t h e r or not in his youth he dreamed dreams of the sea or only, when the chains were tightened, glowed over Hakluyt or Conrad, or laughed with Jacobs, everyone must hear that appeal. If he can
PUBLIC
Four reports on cancer have been issued; artificial light treatment has been kept under observation, and a word of caution as to its indiscriminate use is given. Port Sanitary Control calls for little comment. The health of the merchant seaman still remains under the care of the Board of Trade, despite the fact that its complete transference to the Ministry of Health is lo.ng overdue. A future W o r l d Health Service is not so impracticable as it appears at first sight.. Already the League of Nations Health Organisation has done much to establish a liaison between hygienists of all countries. Interchange visits of medical officers and investigation of disease continue unabated, and the International Sanitary Conference held in Paris has strengthened the general quarantine arrangements in most countries. No change is announced in the somewhat casual and obsolete methods of quarantine applied in British Ports. Sir George Newman's final summary for the year under review is direct, emphatic and encouraging. The medical officer of health is implored not to become customary or routine in thought, action or outlook, but to develop a thirst for knowledge and to possess foresight, a sound historical sense, and a high purpose. Without these latter characteristics he is scarcely earning his public pay. Even now, there is a great national awakening to the importance and value of preventive medicine; but there must be no slackening of effort, for much remains to be done. It is a matter of human endeavour.
The Health of London in 1926. R. F. N. K A Y M E N Z I E S ' annual report the y e a r 1926 provides abundant material for the study of statistical epidemiology, but a report upon the health of the Metropolis must necessarily be large, and it is not possible to refer more than briefly to several sections which are of particular interest. A somewhat serious view is taken of the progressive spread of small-pox in the Midland and Northern Counties in recent years. The number of cases occurring outside London has increased from 973 in 1922 to 10,141 in 1926, whilst the Metropolitan area has remained comparatively free from the disease. The high proportion of the un-
D for
HEALTH. vaccinated section of the population gives rise to some apprehension when consideration is given to the fact that it is hardly reasonable to assume that London will retain its immunity indefinitely. It is satisfactory to note that tim slow, but steady, decline in the mortality rate of tuberculosis, which has been recorded in recent years, has been maintained. A disturbing feature in connection with what might otherwise be termed a profitable phase of public health work, is the remarkable increase in the mortality from phthisis among y o u n g adults, especially among y o u n g women, during the past ten years. This increase is not only relative, but actual. T h e explanation offered is that women entered into business pursuits during the W a r , and, in the course of time, they have displaced men in certain occupations and thus have reduced their husbands' earning capacity. The death rate from cancer shows a further slight advance. Dr. Menzies points out, however, that much of the increase shown in the annual rates, since the beginning of this century does not represent actual increase in the incidence of the disease, but is the result of the increased proportion of persons of higher age in the London population, which has in recent years been further accentuated by the rapid decrease in the birth-rate. The statistics given in the section of the report relating to rheumatism in childhood justify the efforts which are being made by local authorities to stem the ravages of this condition. Whereas in 1919, 20'5 per cent of the chronic invalidity in London school children was due to tuberculosis, and 14"5 per cent was due to rheumatism, in 1926 only 12 per cent was due to tuberculosis and 24 per cent to rheumatism. This remarkable change is due not to an increase in the latter disease, but to the fact that administrative measures have diminished the former. Practically onethird of the children recommended for admission to physically defective schools in London during 1926 were suffering from noncongenital heart disease. These figures illustrate the importance of the unit of 60 beds established for rheumatic children at Queen Mary's Hospital, Carshalton, in November, 1926. It is to be hoped that, as the result of the experience to be gained at Queen M a r y ' s Hospital and the other Metropolitan Asylums Board institutions where additional rheumatism beds are to be provided, local authorities
6
PUBLIC HEALTH.
will recognise that rheumatic fever calls for their immediate attention. Out-door education for London children is provided at five open-air schools for nontuberculous children accommodating 1,070 pupils, five open-air schools for tuberculous children with 365 pupils, five country camp schools accommodating 484 children for short periods and providing for about 4,700 children annually, and 137 open-air classes in connection with ordinary open-air schools providing for children between the ages of two and five years. By the year 1929, four additional open-air schools for non-tuberculous children will have been established. Dr. Menzies reports that the efforts of the County Council in this direction have been attended with very good results, and judging from " after-care " reports the expenditure of money on these schools is proving a wise investment. Of a group of 200 children who attended one of the schools, not one had had a return of his original affection, and all but four are settled in useful occupations. It is interesting to note the circumstances which led to. the establishment of a hospital ~lass for children suffering from lupus vulgaris. Several years ago there were, in the Light Department of the London Hospital, about twenty children undergoing treatment for this disease. All were unfit for school owing to the extent and severity of the disease ; some had not attended for several years. There were, amongst them, children from different parts of the country, who had come especially to London for treatmept, and these were boarded o u t . T h e y were not receiving education, and were without the benefits of school teaching and social supervision. As a result of representations by the medical officer in charge of the Light Department, a school was opened in April, 19:25. T o fit in with the arrangements for treatment at the London Hospital, the girls attend in the forenoon, and the boys in the afternoon. The educational attainments of the children vary owing to the different ages, and the lorig periods of absence from school. H a n d w o r k enters largely into the curriculum. The school is performing very necessary work, and its vaiue cannot be measured by the small number of pupils. This report covers the first twelve months of Dr. Menzies' service as County Medical Officer, and is a worthy successor to the splendid series of reports from the pen of Sir William Hamer.
Oc'ro~z~,
Hygiene in the Mercantile Marine. H I S is to beg that all into whose hands
this number of PUBLIC HEALTH comes will T read the presidential address of Dr. HowardJones, of Newport, to the Services Group of the Society on " H y g i e n e in the Mercantile Marine " ; to b e g that having savoured the sense of national and professional shame that that reading must engender they will not conceal its existence. W h a t Dr. Howard-Jones has to say with regard to the conditions that even to-day exist on English ships, so far as accommodation for the crews is concerned, should be known throughout the land. Also it should be known that so far as requirements b y the Government are concerned, while in other lands--Australia, for example, and Norway and Sweden--these are definite, and it is insisted that real attention shall be given to the hygiene of the quarters provided for the crew so that a reasonable amount of sanitary comfort and decency may be assured, here in the country that even the most sophisticated believes to have been the cradle of seamanship and to be the mistress of the seas, and the youngest knows to be immeasurably deep in the debt of seamen, the department responsible - - t h e Board of Trade--demands, in effect, nothing. Offering only a suggestion here and there to the owner, it accepts and approves as satisfactory , arrangements that the Australian, the Norwegian and the Swedish shipbuilder discards as vile, if by chance an English vessel comes into his possession. Dr. Howard-Jones submits his facts almost too dispassionately, but perhaps the very bareness of his statements makes the situation all the more pitiable ; fills, and must fill, everyone who reads them with a desire to. do everything possible to secure something better for men who, apparently asking for little, deserve so much. Medical Officers of Health of Ports, so this paper reveals, have been trying for years to obtain improvements. Apparently little or no effect has been produced so far as the Board of Trade is concerned. They need help, the help of every medical officer of health in the country, and of all others that each one of these can rouse. Dr. Howard-Jones does not, in words, appeal for that help; yet the appeal is there. W h e t h e r or not in his youth he dreamed dreams of the sea or only, when the chains were tightened, glowed over Hakluyt or Conrad, or laughed with Jacobs, everyone must hear that appeal. If he can