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THE PUBLIC HEALTH
649 of allowing a full cylinder of any to pass into inexperienced hands is gas
danger
compressed first eight factors one
which
of mortality, having risen from 7 to 16 per 100,000 of population within a decade.
Suicide constitutes another group of avoidable deaths scarcely requires emphasis. which has increased since 1920. The suicide-rate increases with age and, if allowance is made for the Unregistered Dentist Fined The substantial fine of :&bgr;I00 (with the alternative ageing of the population, it is actually lower than of three months’ imprisonment in default) was inflicted before the war for men though not for women. The at Hull last week on a dental mechanic for practising statistics show the increasing popularity of coal gas dentistry without being a registered dentist. It -was as an agent of self-destruction. There is no evidence stated that he had been fined on three previous that the gloomy months of the year drive people to
occasions for similar offences. A woman for whom the accused had made an extraction said that she afterwards suffered severe pain ; she had since been obliged to attend a qualified dentist for removal of broken pieces of tooth left in her. gums. If any members of the public still believe that any unregistered practitioner must have some special skill, they may note that the stipendiary magistrate, in refusing an application for time in which to pay the fine, told the defendant that he was a danger, and should be locked up as long as possible. A
Warning
The Secretary of the Royal Medical Benevolent Fund informs us that a man called at the office of the fund last month who gave his name as Dr. John Alexander Thomson, and stated that he had qualified in 1920. He said that he had been suffering from tuberculosis and had been in Switzerland for treatment for two years, that he had recently been in St. Leonard’s Hospital, Shoreditch, and that he was now anxious to go to Liverpool, where he had been offered a post as ship’s surgeon for short sea trips on the Cunard Line. Reference to the Medical Register shows that Dr. John Alexander Thomson’s name was included from 1920 to 1931, but is omitted in 1932. Inquiry has established the fact that Dr. John Alexander Thomson died at Huddersfield on July 16th, 1931. It would thus appear that an impostor is using the name of a former registered medical
practitioner. THE PUBLIC HEALTH
ANNUAL REPORT OF THE CHIEF MEDICAL OFFICER OF THE MINISTRY OF HEALTH
Sir George Newman’s annual report for 193111 shows that the falling birth-rate and death-rate have just about cancelled each other out, the population of Great Britain in April, 1931, being 44,790,485. The two principal forms of death, as in previous years, were diseases of the heart (206 per thousand deaths) and cancer (121 per thousand). These are followed by diseases of the nervous system and sense organs (82 per thousand) and tuberculosis of the respiratory system (60 per thousand). Between the ages of 65 the corresponding figures of these four 16 and are : 167, 155, 77, and 141. Attention is groups drawn to the high proportion of deaths from violence and lack of care among illegitimate children (6266 per million) compared with the legitimate (78 per
million).
There has been
an
astonishing saving
of
life during the first 12 months, particularly in deaths from bronchitis, pneumonia, diarrhoea, and enteritis. This is ascribed in large part to increased maternal care, brought about through education of the mother. An important cause of avoidable death is road accidents, the toll of which now stands among the 1 H.M. Stationery Office.
1932.
Pp. 259.
4s.
take their lives ; the maximum incidence was found in March, April, and June, and the minimum in November, December, and February. England and Wales lost during the year a total of 26tmillion weeks’ work among the insured population from sickness and disability for which benefit was
payable. THE MOTHER AND CHILD
In ’1931 2601 deaths were directly due to childbearing. The puerperal death-rate was 4-11 per thousand live births, the lowest recorded since 1927 ; the rate for puerperal sepsis was 1-92, and here also a slight decrease is noted. The chief medical officer surveys the recent reports on maternal mortality from the general and regional standpoints. Under the Local Government Act, 1929, the responsibility of administering Part I. of the Children Act, 1908, was transferred from the poor-law authorities to county and county borough councils and to autonomous maternity and child welfare authorities. These departments had not usually had previous experience of this work, which has sometimes been overlooked and neglected. In most areas the health visitor has been appointed infant life protection visitor, so that all children under the age of 7 are supervised by a trained officer. It is desirable that the health visitor should have special teaching in the supervision of a nurse child, for the work involves ascertainment as well as report on the suitability of the home and the health of the child. An appeal is made to voluntary organisations to find suitable homes. After the second year of life morbidity replaces mortality as the chief health problem. Despite the increasing use of infant welfare centres, a large proportion of children are still found to be suffering from defects and ailments at the first school medical examination. Mothers have been taught far more about the care of the infant than of the toddler, and there has been little reliable systematic observation of the development of the pre-school child. Arrangements for home visiting are rarely adequate to cope with problems arising during the difficult period of adjustment between infancy and childhood. Provision should be made for both mental and physical care during this period. At the end of 1931 2680 nurses were engaged in health visiting work. There were some 1000 ante natal centres provided by local authorities and some 200 voluntary clinics ; postnatal and gynaecological clinics were insufficient in number. Some 1900 infant welfare centres are under local authorities and over 800 under voluntary bodies; a number of new buildings have been erected for their accommodation, often providing room for the school medical service in addition. Twenty-one day nurseries are provided by local authorities and four times this number by voluntary bodies. Convalescent treatment is available for expectant and nursing mothers and small children in 52 voluntary and 17 municipal homes, while 128 voluntary homes and 5 provided by local authorities take in mothers and babies.
650 INFECTIOUS DISEASES
There
was a
great reduction in the prevalence of
small-pox, bearing
the regulations to include more frequent testing of certain herds. No herd owner can hope to attain or retain a designated milk licence if he attempts to immunise his cattle by the use of a vaccine, for every animal will react to the tuberculin test. The jam standards adopted recently by the Food Manufacturers’ Federation have been widely criticised as unduly low. Sir George Newman says that the in the jam trade in recent years has tendency undoubtedly been to reduce the amount of fruit and to rely on " improved " methods of manufacture to retain the appearance, consistency, and taste of the older " home made " article. Strictly speaking, the insignificant proportion of expensive whole-fruit jam is the only jam entitled to the term " first class " or " full fruit standard." The practice of polishing a film of paraffin wax seems with thin apples very to be harmless and is said to preserve the fruit. A more doubtful practice is the dyeing of oranges to improve their colour ; when dye conceals unripeness or inferiority its use may be an infringement of the Food and Drugs Act, 1928.
out the impression that the disease increases in any district for four or five years and then declines. There was also a substantial decrease in enteric fever. Diphtheria immunisation has become much more popular and has given strikingly good results ; unfortunately no such claim can yet be made for immunisation against scarlet fever. The -value of convalescent serum in preventing and treating measles is now placed beyond doubt. One of the outstanding epidemiological features of the year was the rise in the incidence of cerebro-spinal fever, following that of the previous year. There was a continued decline in acute poliomyelitis and encephalitis lethargica. The influenza epidemic of the year was mild and showed no unusual features. The total number of deaths from tuberculosis was 35,818. There has been a decline in the deathrate from all forms, though in varying degrees. The Ministry attach great importance to the ascertainment of all cases ; in most cases, it is held, the source of infection can be traced if contacts are examined. A negative reaction to tuberculin is reliable and useful THE SERVICES in eliminating suspects. Tuberculosis schemes are in a stage of transition at the present time, but ROYAL NAVAL MEDICAL SERVICE increasing use is being made of dispensaries and of Lt. W. M. Greer is transferred to the Permanent List. Surg. beds for observation. Artificial light is held to have Lt. (D) W. E. L. Brigham to be Surg. Lt.-Comdr. (D). Surg. a definite importance in treatment. The Ministry i W. P. Culbertson to be Surg. Lt. has investigated the salt-free diets recommended in The following appts. are notified : Surg. Comdrs. E. L. to Pembroke, for R.N. Barracks ; N. A. H. Germany, but finds that they are expensive, involve Markham to Cairo, and as squadron medical officer ; G. E. administrative difficulty and expense, and are disliked Barlow Heath to Excellent;H. L. Peregrine to Victory, for R.N. by the patients. Their value is insufficiently Barracks ; J. D. Bangay to Hawkin.-;/ J. C. Brown to established to justify extended trial. Royal Sovereign ;M. B. Macleod to Malaya;L. A. Moncrieff to Victory, for Portsmouth ; and T. G. B. Crawford to The mortality for rheumatic fever shows a gratifying Pembroke, for R.N. Barracks. decrease in 1931, and a decrease in the death-rate Surg. Lt.-Comdrs. (D) D. Barker to Pembroke for R.N. from heart disease in the younger age-groups is also Barracks, Chatham ; A. D. MeHaffie to President, add]., course ; and W. E. A. Sampson to Pembroke, for R.M. recorded ; the continued high figure for heart disease for Deal. Infirmary, is largely fictitious, being due to the increase in the Surg. Lts. J. B. W. Rowe to Victory, for R.N. Barracks ; age of the population and to the change in the form J. G. Lynch to Vivid, for R.N. Barracks ; and H. S. Marks of death certificates. The research and clinical work to Pembroke, for R.N. Barracks, Chatham. Lts. (D) P. S. Turner to Victory, for Haslar Hospital ; carried on during the year on acute and chronic L. Surg. F. Fairey to Sandhurst; and A. W. Y. Price to Sussex. rheumatism is reviewed. ROYAL NAVAL VOLUNTEER RESERVE At the end of 1931 189 venereal disease treatment centres were available ; a number of centres have Surg. Lt. W. Lennon is appointed to Victory, for -R.N. increased their facilities for treatment. It is not yet Hospital, Haslar. possible to estimate accurately the amount of delay ROYAL ARMY MEDICAL CORPS in seeking advice, but in centres where accurate Lt. R. D. MacRae resigns his commn. figures are kept a gratifying improvement in the RESERVE OF OFFICERS promptitude with which the men come for treatment is noticed, though women still delay. Nevertheless, Lt.-Col. B. S. Bartlett, having attained the age limit of there is a decline in syphilis in women, which is liability to recall, ceases to belong to the Res. of Off. ascribed to increased education. There seems to be TERRITORIAL ARM? no reduction in the amount of gonorrhoea in the D. J. Davies to be Maj. Capt. Lt. E. G. Mackie (late R. Scots) to be Capt., and relinquishes country. Experiments in the use of vaccines suggest that, except at the early stages, the titre of the the rank of Lt. complement-fixation reaction can be raised considerINDIAN MEDICAL SERVICE ably by a vaccine, and at the same time the organisms The undermentioned officers have vacated appts. in disappear. India : A.D. M.S. :: lIaj.-Gen. T. G. F. Paterson. D.A.D’s.P.:Maj. L. Dunbar, R.A.M.C., and Maj. N. T. FOOD AND DRINK Whitehead, R.A.M.C. The work of the Ministry in relation to individual The undermentioned appts. have been made : and national health and the safeguarding- of food D.A.D.M.S. : Maj. R. D. Cameron, R.A.M.C. A.D.P.:: L. Dunbar, R.A.M.C. from deficiency, adulteration, and transmissible Maj. disease is discussed. About 15,000 cattle were ROYAL AIR FORCE included in licensed herds during 1931. The double Dental Branch.-The undermentioned are granted nonintradermal tuberculin test, although it has been permanent commissions as Flying Officers : H. Keggin strongly criticised, has been found to be much more and V. H. Weeks. reliable in skilled hands than have other methods. COLONIAL MEDICAL SERVICE Laxity in complying with the regulations has been Dr. H. D. Weatherhead (Assistant Medical Officer, British the cause of disaster in several herds ; it may be Guiana) has been apptd. Supernumerary Medical Officer, necessary to adopt more severe penalties and to revise Leeward Islands.
danger
compressed first eight factors one
which
of mortality, having risen from 7 to 16 per 100,000 of population within a decade.
Suicide constitutes another group of avoidable deaths scarcely requires emphasis. which has increased since 1920. The suicide-rate increases with age and, if allowance is made for the Unregistered Dentist Fined The substantial fine of :&bgr;I00 (with the alternative ageing of the population, it is actually lower than of three months’ imprisonment in default) was inflicted before the war for men though not for women. The at Hull last week on a dental mechanic for practising statistics show the increasing popularity of coal gas dentistry without being a registered dentist. It -was as an agent of self-destruction. There is no evidence stated that he had been fined on three previous that the gloomy months of the year drive people to
occasions for similar offences. A woman for whom the accused had made an extraction said that she afterwards suffered severe pain ; she had since been obliged to attend a qualified dentist for removal of broken pieces of tooth left in her. gums. If any members of the public still believe that any unregistered practitioner must have some special skill, they may note that the stipendiary magistrate, in refusing an application for time in which to pay the fine, told the defendant that he was a danger, and should be locked up as long as possible. A
Warning
The Secretary of the Royal Medical Benevolent Fund informs us that a man called at the office of the fund last month who gave his name as Dr. John Alexander Thomson, and stated that he had qualified in 1920. He said that he had been suffering from tuberculosis and had been in Switzerland for treatment for two years, that he had recently been in St. Leonard’s Hospital, Shoreditch, and that he was now anxious to go to Liverpool, where he had been offered a post as ship’s surgeon for short sea trips on the Cunard Line. Reference to the Medical Register shows that Dr. John Alexander Thomson’s name was included from 1920 to 1931, but is omitted in 1932. Inquiry has established the fact that Dr. John Alexander Thomson died at Huddersfield on July 16th, 1931. It would thus appear that an impostor is using the name of a former registered medical
practitioner. THE PUBLIC HEALTH
ANNUAL REPORT OF THE CHIEF MEDICAL OFFICER OF THE MINISTRY OF HEALTH
Sir George Newman’s annual report for 193111 shows that the falling birth-rate and death-rate have just about cancelled each other out, the population of Great Britain in April, 1931, being 44,790,485. The two principal forms of death, as in previous years, were diseases of the heart (206 per thousand deaths) and cancer (121 per thousand). These are followed by diseases of the nervous system and sense organs (82 per thousand) and tuberculosis of the respiratory system (60 per thousand). Between the ages of 65 the corresponding figures of these four 16 and are : 167, 155, 77, and 141. Attention is groups drawn to the high proportion of deaths from violence and lack of care among illegitimate children (6266 per million) compared with the legitimate (78 per
million).
There has been
an
astonishing saving
of
life during the first 12 months, particularly in deaths from bronchitis, pneumonia, diarrhoea, and enteritis. This is ascribed in large part to increased maternal care, brought about through education of the mother. An important cause of avoidable death is road accidents, the toll of which now stands among the 1 H.M. Stationery Office.
1932.
Pp. 259.
4s.
take their lives ; the maximum incidence was found in March, April, and June, and the minimum in November, December, and February. England and Wales lost during the year a total of 26tmillion weeks’ work among the insured population from sickness and disability for which benefit was
payable. THE MOTHER AND CHILD
In ’1931 2601 deaths were directly due to childbearing. The puerperal death-rate was 4-11 per thousand live births, the lowest recorded since 1927 ; the rate for puerperal sepsis was 1-92, and here also a slight decrease is noted. The chief medical officer surveys the recent reports on maternal mortality from the general and regional standpoints. Under the Local Government Act, 1929, the responsibility of administering Part I. of the Children Act, 1908, was transferred from the poor-law authorities to county and county borough councils and to autonomous maternity and child welfare authorities. These departments had not usually had previous experience of this work, which has sometimes been overlooked and neglected. In most areas the health visitor has been appointed infant life protection visitor, so that all children under the age of 7 are supervised by a trained officer. It is desirable that the health visitor should have special teaching in the supervision of a nurse child, for the work involves ascertainment as well as report on the suitability of the home and the health of the child. An appeal is made to voluntary organisations to find suitable homes. After the second year of life morbidity replaces mortality as the chief health problem. Despite the increasing use of infant welfare centres, a large proportion of children are still found to be suffering from defects and ailments at the first school medical examination. Mothers have been taught far more about the care of the infant than of the toddler, and there has been little reliable systematic observation of the development of the pre-school child. Arrangements for home visiting are rarely adequate to cope with problems arising during the difficult period of adjustment between infancy and childhood. Provision should be made for both mental and physical care during this period. At the end of 1931 2680 nurses were engaged in health visiting work. There were some 1000 ante natal centres provided by local authorities and some 200 voluntary clinics ; postnatal and gynaecological clinics were insufficient in number. Some 1900 infant welfare centres are under local authorities and over 800 under voluntary bodies; a number of new buildings have been erected for their accommodation, often providing room for the school medical service in addition. Twenty-one day nurseries are provided by local authorities and four times this number by voluntary bodies. Convalescent treatment is available for expectant and nursing mothers and small children in 52 voluntary and 17 municipal homes, while 128 voluntary homes and 5 provided by local authorities take in mothers and babies.
650 INFECTIOUS DISEASES
There
was a
great reduction in the prevalence of
small-pox, bearing
the regulations to include more frequent testing of certain herds. No herd owner can hope to attain or retain a designated milk licence if he attempts to immunise his cattle by the use of a vaccine, for every animal will react to the tuberculin test. The jam standards adopted recently by the Food Manufacturers’ Federation have been widely criticised as unduly low. Sir George Newman says that the in the jam trade in recent years has tendency undoubtedly been to reduce the amount of fruit and to rely on " improved " methods of manufacture to retain the appearance, consistency, and taste of the older " home made " article. Strictly speaking, the insignificant proportion of expensive whole-fruit jam is the only jam entitled to the term " first class " or " full fruit standard." The practice of polishing a film of paraffin wax seems with thin apples very to be harmless and is said to preserve the fruit. A more doubtful practice is the dyeing of oranges to improve their colour ; when dye conceals unripeness or inferiority its use may be an infringement of the Food and Drugs Act, 1928.
out the impression that the disease increases in any district for four or five years and then declines. There was also a substantial decrease in enteric fever. Diphtheria immunisation has become much more popular and has given strikingly good results ; unfortunately no such claim can yet be made for immunisation against scarlet fever. The -value of convalescent serum in preventing and treating measles is now placed beyond doubt. One of the outstanding epidemiological features of the year was the rise in the incidence of cerebro-spinal fever, following that of the previous year. There was a continued decline in acute poliomyelitis and encephalitis lethargica. The influenza epidemic of the year was mild and showed no unusual features. The total number of deaths from tuberculosis was 35,818. There has been a decline in the deathrate from all forms, though in varying degrees. The Ministry attach great importance to the ascertainment of all cases ; in most cases, it is held, the source of infection can be traced if contacts are examined. A negative reaction to tuberculin is reliable and useful THE SERVICES in eliminating suspects. Tuberculosis schemes are in a stage of transition at the present time, but ROYAL NAVAL MEDICAL SERVICE increasing use is being made of dispensaries and of Lt. W. M. Greer is transferred to the Permanent List. Surg. beds for observation. Artificial light is held to have Lt. (D) W. E. L. Brigham to be Surg. Lt.-Comdr. (D). Surg. a definite importance in treatment. The Ministry i W. P. Culbertson to be Surg. Lt. has investigated the salt-free diets recommended in The following appts. are notified : Surg. Comdrs. E. L. to Pembroke, for R.N. Barracks ; N. A. H. Germany, but finds that they are expensive, involve Markham to Cairo, and as squadron medical officer ; G. E. administrative difficulty and expense, and are disliked Barlow Heath to Excellent;H. L. Peregrine to Victory, for R.N. by the patients. Their value is insufficiently Barracks ; J. D. Bangay to Hawkin.-;/ J. C. Brown to established to justify extended trial. Royal Sovereign ;M. B. Macleod to Malaya;L. A. Moncrieff to Victory, for Portsmouth ; and T. G. B. Crawford to The mortality for rheumatic fever shows a gratifying Pembroke, for R.N. Barracks. decrease in 1931, and a decrease in the death-rate Surg. Lt.-Comdrs. (D) D. Barker to Pembroke for R.N. from heart disease in the younger age-groups is also Barracks, Chatham ; A. D. MeHaffie to President, add]., course ; and W. E. A. Sampson to Pembroke, for R.M. recorded ; the continued high figure for heart disease for Deal. Infirmary, is largely fictitious, being due to the increase in the Surg. Lts. J. B. W. Rowe to Victory, for R.N. Barracks ; age of the population and to the change in the form J. G. Lynch to Vivid, for R.N. Barracks ; and H. S. Marks of death certificates. The research and clinical work to Pembroke, for R.N. Barracks, Chatham. Lts. (D) P. S. Turner to Victory, for Haslar Hospital ; carried on during the year on acute and chronic L. Surg. F. Fairey to Sandhurst; and A. W. Y. Price to Sussex. rheumatism is reviewed. ROYAL NAVAL VOLUNTEER RESERVE At the end of 1931 189 venereal disease treatment centres were available ; a number of centres have Surg. Lt. W. Lennon is appointed to Victory, for -R.N. increased their facilities for treatment. It is not yet Hospital, Haslar. possible to estimate accurately the amount of delay ROYAL ARMY MEDICAL CORPS in seeking advice, but in centres where accurate Lt. R. D. MacRae resigns his commn. figures are kept a gratifying improvement in the RESERVE OF OFFICERS promptitude with which the men come for treatment is noticed, though women still delay. Nevertheless, Lt.-Col. B. S. Bartlett, having attained the age limit of there is a decline in syphilis in women, which is liability to recall, ceases to belong to the Res. of Off. ascribed to increased education. There seems to be TERRITORIAL ARM? no reduction in the amount of gonorrhoea in the D. J. Davies to be Maj. Capt. Lt. E. G. Mackie (late R. Scots) to be Capt., and relinquishes country. Experiments in the use of vaccines suggest that, except at the early stages, the titre of the the rank of Lt. complement-fixation reaction can be raised considerINDIAN MEDICAL SERVICE ably by a vaccine, and at the same time the organisms The undermentioned officers have vacated appts. in disappear. India : A.D. M.S. :: lIaj.-Gen. T. G. F. Paterson. D.A.D’s.P.:Maj. L. Dunbar, R.A.M.C., and Maj. N. T. FOOD AND DRINK Whitehead, R.A.M.C. The work of the Ministry in relation to individual The undermentioned appts. have been made : and national health and the safeguarding- of food D.A.D.M.S. : Maj. R. D. Cameron, R.A.M.C. A.D.P.:: L. Dunbar, R.A.M.C. from deficiency, adulteration, and transmissible Maj. disease is discussed. About 15,000 cattle were ROYAL AIR FORCE included in licensed herds during 1931. The double Dental Branch.-The undermentioned are granted nonintradermal tuberculin test, although it has been permanent commissions as Flying Officers : H. Keggin strongly criticised, has been found to be much more and V. H. Weeks. reliable in skilled hands than have other methods. COLONIAL MEDICAL SERVICE Laxity in complying with the regulations has been Dr. H. D. Weatherhead (Assistant Medical Officer, British the cause of disaster in several herds ; it may be Guiana) has been apptd. Supernumerary Medical Officer, necessary to adopt more severe penalties and to revise Leeward Islands.