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THE MEDICAL WHO'S WHO.
1256
extraordinary happenings, a selection of which appeared in the Proceedings of the Society, which had a branch of its own in Dublin. Barrett’s friends could not always keep up with one whose eagerness to follow clues made companionship stimulating to the point of unrest, but fully recognised the transparent honesty and simplicity of his character and his readiness to undertake any labour to get phenomena properly observed and recorded. He was, as Sir Oliver Lodge reminds us, never deterred by ridicule or opprobrium from following such clues as he could find. Death did not seem to Barrett to be an interrupter of mental continuity, and he did not fear it.
extra chlorination; established for the homeless; made for the removal of refuse; arrangement carcasses of dead animals were burned and buried. One result of the disaster will certainly be an improvement in public hygiene. In our crowded country, with a local sanitary authority in every district, it is difficult to realise the great responsibility thrown upon State departments administering huge sparsely inhabited districts in which there is practically The State Department no local health organisation. of Public Health in Illinois is to be congratulated on the promptitude exhibited in dealing with the effects of the tornado.
organised
tent
subjected to
were were were
camps
____
THE
HYGIENE
OF
A TORNADO.
AT 2.28 P.M. on March 18th last a tornado travelling ,at the rate of 60 miles an hour along a path about a mile wide struck the town of Gorham in Illinois, and crossed five counties, remaining in contact with the ground the whole time. The population of the devastated territory numbered about 200,000, being largely rural with one or two towns of up to 10,000 or 12,000 inhabitants. Among this population the local public health service was mostly in a primitive state, and the Illinois Health News for May gives an account of steps taken by the State Health Department to deal with the problem. The towns of Murphysboro’ and West Frankfort had public watersupplies, but in most parts of the area drinkingwater was obtained from private wells and cisterns, many of the former liable to surface pollution. There was no local control over milk-supplies in the area before the tornado and the only pasteurisation plant was at West Frankfort. At Murphysboro’ and West Frankfort there were public sewerage - system ; otherwise privies were the rule. None of the communities had a system for the collection of - refuse. Many hundreds of horses and cows and -domestic animals were killed by the tornado. Many people were rendered homeless. The first news of the disaster reached Springfield at 8 P.M. on the same day, and a special train left with a rescue party on board, arriving at Murphysboro’ at 2 A.M. the following morning. By the morning of the 20th the five sanitary engineers of the State Department were in the area, and within 36 hours a complete health department was functioning with headquarters at Carbondale. Medical and nursing relief to the :injured was provided, the dangers of communicable -diseases were met by isolation and immunisation, and sanitary measures were adopted. All the work was done in close cooperation with the military authorities, who were charged by Governor Small with the responsibilities of relief and re-habitation. The medical and nursing relief work was turned over to the Red Cross organisation on the second Sunday after the disaster. Temporary emergency work was :followed by organisation on a permanent basis to handle problems which are sure to continue for a year or more. A diagnostic laboratory was established at ’Carbondale, while the sanitary work was extended to include control of the water-supply, the milksupplies, and the disposal of refuse. There has always been an excessive prevalence of typhoid fever and -nalaria in this area, and the prevention of both these diseases received attention. During the first two weeks about 4000 persQns were immunised against typhoid, and probably about 20,000 will have been inoculated before the campaign ends. In the wake of the storm there arose conditions extremely favourable to the development of epidemics, especially typhoid fever. The injured were A month liable to tetanus and gas gangrene. after the disaster no epidemics of any kind had appeared in the affected area. Only five or six deaths resulted from tetanus and gangrene among the thousands who were injured. The activity of the State Health Department in the tornado zone and the success of their operations has created a demand for a permanent local health organisation. Wells and water-supplies which were temporarily dis-
MEDICAL WHO’S WHO. THE seventh edition of this work of reference, dated 1925, has just reached us, regret being expressed for the delay, which is attributed largely to the entire resetting and alteration in size from former editions. The last appearance of the volume was in 1918, when, owing to the death of its then editor, it fell into abeyance. In this volume such consultants and specialists as have returned the forms supplied to them have taken the opportunity of stating precisely the nature of their work, and general practitioners have indicated in many cases the professional studies in which they are particularly interested. At the end is an alphabetical index of towns with the names of practitioners there resident. The volume contains, besides, certain personal data which are otherwise not accessible. The list of questions to practitioners, on the answers to which the book is based, was submitted to the General Medical Council, which took no objection to them. The volume contains no name which does not appear in the Medical Register. It is well printed and produced in handy form for the reference shelf. The price is 30s., from the Grafton Publishing Company, Ltd., 8, Stone Buildings, Lincoln’s Inn, London, W.C. 2. THE
PEMPHIGUS
NEONATORUM.
Two recent outbreaks of pemphigus neonatorum in maternity homes have induced the Ministry of Health to issue a Memorandum1 on the subject. In the first outbreak 23 babies were more or less severely infected, the disease appearing first round the fingernails and spreading thence to other parts of the body. Three mothers suffered from mammary disease, and there were two cases of puerperal fever, one of which proved fatal. In the second outbreak the number of cases was much smaller ; all were slight in degree, and there was no infection among the mothers. There were no fatal cases in either outbreak and in neither could the source of the infection be ascertained. The Memorandum distinguishes between a mild type of pemphigus associated with little or no systemic disturbance and recovering within a few weeks, and a grave type which usually terminates in pulmonary oedema, the latter being the result of infection from an unhealed umbilical wound. No definite pronouncement is made as to the true causal organism, although most authorities consider pemphigus to be an infantile form or variant of contagious impetigo. In the mild type the portal of entry is presumed to be some slight lesion of the skin, the carrier being the mother, nurse, or midwife, either directly or through infected clothing, to which the infective agent seems to adhere with great tenacity. In the majority of outbreaks the attending midwife is the suspect; in one instance a small pustule was found on the midwife’s finger, but examination has often failed to reveal any infective lesion. The first requirement in prevention is early diagnosis, and the Memorandum regrets the lateness in some cases of the report made to the local supervising authority. The midwife or nurse suspected of being the agent of spread should be suspended from practice until 1 Memo. 103 Med.
H.M. Stationery Office. 1d.
extraordinary happenings, a selection of which appeared in the Proceedings of the Society, which had a branch of its own in Dublin. Barrett’s friends could not always keep up with one whose eagerness to follow clues made companionship stimulating to the point of unrest, but fully recognised the transparent honesty and simplicity of his character and his readiness to undertake any labour to get phenomena properly observed and recorded. He was, as Sir Oliver Lodge reminds us, never deterred by ridicule or opprobrium from following such clues as he could find. Death did not seem to Barrett to be an interrupter of mental continuity, and he did not fear it.
extra chlorination; established for the homeless; made for the removal of refuse; arrangement carcasses of dead animals were burned and buried. One result of the disaster will certainly be an improvement in public hygiene. In our crowded country, with a local sanitary authority in every district, it is difficult to realise the great responsibility thrown upon State departments administering huge sparsely inhabited districts in which there is practically The State Department no local health organisation. of Public Health in Illinois is to be congratulated on the promptitude exhibited in dealing with the effects of the tornado.
organised
tent
subjected to
were were were
camps
____
THE
HYGIENE
OF
A TORNADO.
AT 2.28 P.M. on March 18th last a tornado travelling ,at the rate of 60 miles an hour along a path about a mile wide struck the town of Gorham in Illinois, and crossed five counties, remaining in contact with the ground the whole time. The population of the devastated territory numbered about 200,000, being largely rural with one or two towns of up to 10,000 or 12,000 inhabitants. Among this population the local public health service was mostly in a primitive state, and the Illinois Health News for May gives an account of steps taken by the State Health Department to deal with the problem. The towns of Murphysboro’ and West Frankfort had public watersupplies, but in most parts of the area drinkingwater was obtained from private wells and cisterns, many of the former liable to surface pollution. There was no local control over milk-supplies in the area before the tornado and the only pasteurisation plant was at West Frankfort. At Murphysboro’ and West Frankfort there were public sewerage - system ; otherwise privies were the rule. None of the communities had a system for the collection of - refuse. Many hundreds of horses and cows and -domestic animals were killed by the tornado. Many people were rendered homeless. The first news of the disaster reached Springfield at 8 P.M. on the same day, and a special train left with a rescue party on board, arriving at Murphysboro’ at 2 A.M. the following morning. By the morning of the 20th the five sanitary engineers of the State Department were in the area, and within 36 hours a complete health department was functioning with headquarters at Carbondale. Medical and nursing relief to the :injured was provided, the dangers of communicable -diseases were met by isolation and immunisation, and sanitary measures were adopted. All the work was done in close cooperation with the military authorities, who were charged by Governor Small with the responsibilities of relief and re-habitation. The medical and nursing relief work was turned over to the Red Cross organisation on the second Sunday after the disaster. Temporary emergency work was :followed by organisation on a permanent basis to handle problems which are sure to continue for a year or more. A diagnostic laboratory was established at ’Carbondale, while the sanitary work was extended to include control of the water-supply, the milksupplies, and the disposal of refuse. There has always been an excessive prevalence of typhoid fever and -nalaria in this area, and the prevention of both these diseases received attention. During the first two weeks about 4000 persQns were immunised against typhoid, and probably about 20,000 will have been inoculated before the campaign ends. In the wake of the storm there arose conditions extremely favourable to the development of epidemics, especially typhoid fever. The injured were A month liable to tetanus and gas gangrene. after the disaster no epidemics of any kind had appeared in the affected area. Only five or six deaths resulted from tetanus and gangrene among the thousands who were injured. The activity of the State Health Department in the tornado zone and the success of their operations has created a demand for a permanent local health organisation. Wells and water-supplies which were temporarily dis-
MEDICAL WHO’S WHO. THE seventh edition of this work of reference, dated 1925, has just reached us, regret being expressed for the delay, which is attributed largely to the entire resetting and alteration in size from former editions. The last appearance of the volume was in 1918, when, owing to the death of its then editor, it fell into abeyance. In this volume such consultants and specialists as have returned the forms supplied to them have taken the opportunity of stating precisely the nature of their work, and general practitioners have indicated in many cases the professional studies in which they are particularly interested. At the end is an alphabetical index of towns with the names of practitioners there resident. The volume contains, besides, certain personal data which are otherwise not accessible. The list of questions to practitioners, on the answers to which the book is based, was submitted to the General Medical Council, which took no objection to them. The volume contains no name which does not appear in the Medical Register. It is well printed and produced in handy form for the reference shelf. The price is 30s., from the Grafton Publishing Company, Ltd., 8, Stone Buildings, Lincoln’s Inn, London, W.C. 2. THE
PEMPHIGUS
NEONATORUM.
Two recent outbreaks of pemphigus neonatorum in maternity homes have induced the Ministry of Health to issue a Memorandum1 on the subject. In the first outbreak 23 babies were more or less severely infected, the disease appearing first round the fingernails and spreading thence to other parts of the body. Three mothers suffered from mammary disease, and there were two cases of puerperal fever, one of which proved fatal. In the second outbreak the number of cases was much smaller ; all were slight in degree, and there was no infection among the mothers. There were no fatal cases in either outbreak and in neither could the source of the infection be ascertained. The Memorandum distinguishes between a mild type of pemphigus associated with little or no systemic disturbance and recovering within a few weeks, and a grave type which usually terminates in pulmonary oedema, the latter being the result of infection from an unhealed umbilical wound. No definite pronouncement is made as to the true causal organism, although most authorities consider pemphigus to be an infantile form or variant of contagious impetigo. In the mild type the portal of entry is presumed to be some slight lesion of the skin, the carrier being the mother, nurse, or midwife, either directly or through infected clothing, to which the infective agent seems to adhere with great tenacity. In the majority of outbreaks the attending midwife is the suspect; in one instance a small pustule was found on the midwife’s finger, but examination has often failed to reveal any infective lesion. The first requirement in prevention is early diagnosis, and the Memorandum regrets the lateness in some cases of the report made to the local supervising authority. The midwife or nurse suspected of being the agent of spread should be suspended from practice until 1 Memo. 103 Med.
H.M. Stationery Office. 1d.