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The Welsh National Memorial Association
120
PUBLIC HEALTH.
breast, uterus, rectum, brain, etc.--the reports include a section in which some account of purely experimental investigations is presented.
The Welsh National Memorial Association. HE twenty-first annual report of the King Edward VII Welsh National Memorial Association for the Prevention, Treatment and Abolition of Tuberculosis covers the twelve months ended March 31st, 1933, and contains a compendium of information which is of interest both to the clinician and the public health officer. The Association provides a tuberculosis service for a population of over twoand-a-half million persons, and has under its control 17 institutions, whilst the diagnosis and domiciliary supervision of cases are undertaken by 14 area tuberculosis physicians, most of whom are assisted by one or more assistant physicians. Dr. D. A . Powell (the Principal Medical Officer), in his report, provides tables which show a steady increase in the work of the Association generally, the large amount of work carried out relatively to England as a whole, the close association maintained between the medical staff of the Association and general practitioners, and, in comparison with previous years, the relatively small number of sputum examinations arid a much greater number of X-ray examinations. It has been found that whilst patients are unable or unwilling to provide specimens for bacteriological examination, they gladly seize the opportunity for radiologieal examination, and the provision of these facilities has done an enormous amount of good in popularising the work of the Association. A table given in Dr. Powell's report also shows that the mortality from tuberculosis in Wales has fallen from 1,730 per million in 1901 to 977 i n 1932, and • that .though the non-pulmonary death-rate has fallen from 47/1 to 172 per million inthis period, the pulmonary mortality has not shown an equal decline, the figures for 1901 and 1932 being. 1,256 and 804 respectively. In addition to the institutional and area reports, which contain a wealth of detailed information presented by the physicians in charge thereof, four formal " studies " are included. Dr. Brownlee (Glanely Hospital) describes a number of cases of clinical interest which presented medical or surgical symptoms simulating tuberculosis, and which were diagnosed as a result of the application of methods
T
JANUARY,
which are available or at the disposal of a wellequipped institution. Dr. C. W. Burns describes the results of an investigation into the afterresults of treatment of 143 surgical patients discharged from the St. Bride's Hospital between 1923 and 1927. Seventy per cent. of these cases were found to be fit after six or more years, and six out of a total of eight deaths which had occurred after discharge were of patients who had been removed from hospital against advice. Dr. T. W. Davies presents a study of the association of pulmonary and non-pulmonary conditions in the same patients; and Dr. W. Davies describes a case of tuberculous pericarditis with effusion, which was treated with some success by aspiration followed by air replacement of the fluid withdrawn. Over 3,000 contacts, were examined during the year by the medical staff of the Association, and an interesting table giving the results of contact examinations in Wales, compared with similar figures obtained from Lancashire, quoted from Dr. MacNalty's Report on Tuberculosis, shows that tuberculosis is found twice as often amongst contacts in Wales as in Lancashire, and taking adults alone it is found two-and-a-half times as often. The area physicians do n o t unanimously approve contact examination as a method of discovering cases of tuberculosis, but Dr. Howell Williams describes some striking results in this direction, obtained by the examination of contacts of seven cases in his area. In conjunction with the research department of the Association, work has been carried out in connection with " contacts," into certain " curious " bodies found in the lungs of colliers, coal trimmers and others, and in regard to tuberculin tests in a mental hospital ; whilst Prof. Cummins has pursued his study of the value of gold salts in the treatment of pulmonary tuberculosis, and his search for methods to evaluate their effects. In t h e Association?s central laboratory, under the direction of Dr. W. H. Tytler; an increased amount of routine work has been done, and it is interesting to note that from a study of the bacillary types cultured from 450 cases treated by the staff of the Association, not more than 8 per cent. were found to be of bovine origin. T h o u g h t h e amount of bovine infection amongst human cases appears to be comparatively low in Wales, the Association has taken active measures to encourage the establishment of tubercle-free herds and improve the quality of milk generally, and a joint committee representing the Royal Welsh Agricultural Society
1934.
PUBLIC HEALTH.
and the Association has been set up with this object in view. The educational work of the Association has been vigorously carried on during t h e year. Dr. Owen Morris, the Director of Education, is described as having addressed with apostolic fervour, as many meetings as would tax a Chrysostom ; and the two lady lecturers have given addresses on " Tuberculosis and the Laws of Health " and " Infant Care " (to senior girls) on 1,t75 occasions. The reports of the superintendents of institutions and area physicians show ample evidence of the appreciation of the work of the Association by the public, and of harmonious co-operation with medical practitioners, whilst the numerical preponderance of public health officers on the medical committee of the Association assures that the claims of preventive medicine shall not be overlooked.
121
Tuberculosis again furnished a new low record of 837 per million living. Puerperal sepsis caused the deaths of 1.55 Women per 1,000 live and still births--0.04 less than the rate for 1931, and 0.29 less than 1930. " Other accidents of pregnancy and childbirth " showed a rate of 2.49 per 1,000 live and still births, compared with 2.36 in 1931. The death-rate from suicide was 143 per million persons living, a new high record, the rate for 1931 (the previous highest) being 129. A slow increase in this rate has been continuous for a number of years. Road accidents due to mechanical vehicles were responsible for 5,671 deaths. The figures for the last five years were 4,452, 5,196, 5,752, 6,342 and 5,892 respectively. The volume, which is on sale at H.M. Stationer3; Office, price 6s. net, is one to which reference at intervals by every medical officer of health throughout the year is inevitable.
The Statistical Review of 1932.
p
ART I of the Registrar-General's Statistical Review of England and Wales for the year 1932, containing the medical tables, recently issued, calls for reference here. From the tables relating to births, it is gathered that the number registered in the year was 613,972, giving a rate of 15"3 per 1,000 persons living. This rate is 0.5 below that for 193t, hitherto the lowest on record, and constitutes a new low record. The death-rate was 12.0 per 1,000 persons living, being 0.3 below the rate for 1931, but 0.6 above that for 1930. The rate for 1930 was, however, the lowest ever recorded, and was largely due to the exceptionally mild weather in the first quarter of that year. The higher rate for 1932 is almost wholly occasioned by an excess in the first quarter of the year, the rates for the other three quarters showing very little variation. Infant mortality was similarly affected, and the deaths of children under one year of age numbered 65 per 1,000 live births, against 66 in 1931, and 60 in 1930. 1930 is, however, the only year showing a lower infant mortality than 1932. Cancer showed a death-rate of 1,510 per milion persons living, against 1,484 in 1931. if, however, allowance is made for diffcrences in the age constitution of the population, the comparative mortality from cancer showg a much smaller increase.
After-Histories of Tuberculous Patients. N a special report bearing the title " ResidenI tial Treatment of Tuberculosis : AfterHistories of Patients Discharged during 1921," Sir Frederick Menzies, Medical Officer of Health of the London County Council, reviews the condition in 1931 of 4,160 tuberculous patients (3,528 adults and 632 children) ten years subsequent to their discharge from hospitals and sanatoria during the year 1921. At the end of the ten years, 837 (512 adults and 325 children) were known to be alive; 2,340 (2,193 adults and 147 children) were reported dead, and 983 (823 adults and 160 children) were untraced. The somewhat high proportion of untraced (23 per cent.) introduces a considerable measure of error into the statistics, which must, therefore, be considered as representing a general survey rather than an actuarial study. It is to be noted that the figures for t h e " unt r a c e d " include many patients who were removed frcm the tut:erculosis dispensary registers as " recovered cases," in accordance with the regulaticns ef the Ministry of Health. There is good reason to believe that the greater number of these recovered cases are alive and in good health, and that the number of patients surviving after ten years is, therefore appreciably higher than 837. The various tables show that for the traced cases the mortality of the various types of
PUBLIC HEALTH.
breast, uterus, rectum, brain, etc.--the reports include a section in which some account of purely experimental investigations is presented.
The Welsh National Memorial Association. HE twenty-first annual report of the King Edward VII Welsh National Memorial Association for the Prevention, Treatment and Abolition of Tuberculosis covers the twelve months ended March 31st, 1933, and contains a compendium of information which is of interest both to the clinician and the public health officer. The Association provides a tuberculosis service for a population of over twoand-a-half million persons, and has under its control 17 institutions, whilst the diagnosis and domiciliary supervision of cases are undertaken by 14 area tuberculosis physicians, most of whom are assisted by one or more assistant physicians. Dr. D. A . Powell (the Principal Medical Officer), in his report, provides tables which show a steady increase in the work of the Association generally, the large amount of work carried out relatively to England as a whole, the close association maintained between the medical staff of the Association and general practitioners, and, in comparison with previous years, the relatively small number of sputum examinations arid a much greater number of X-ray examinations. It has been found that whilst patients are unable or unwilling to provide specimens for bacteriological examination, they gladly seize the opportunity for radiologieal examination, and the provision of these facilities has done an enormous amount of good in popularising the work of the Association. A table given in Dr. Powell's report also shows that the mortality from tuberculosis in Wales has fallen from 1,730 per million in 1901 to 977 i n 1932, and • that .though the non-pulmonary death-rate has fallen from 47/1 to 172 per million inthis period, the pulmonary mortality has not shown an equal decline, the figures for 1901 and 1932 being. 1,256 and 804 respectively. In addition to the institutional and area reports, which contain a wealth of detailed information presented by the physicians in charge thereof, four formal " studies " are included. Dr. Brownlee (Glanely Hospital) describes a number of cases of clinical interest which presented medical or surgical symptoms simulating tuberculosis, and which were diagnosed as a result of the application of methods
T
JANUARY,
which are available or at the disposal of a wellequipped institution. Dr. C. W. Burns describes the results of an investigation into the afterresults of treatment of 143 surgical patients discharged from the St. Bride's Hospital between 1923 and 1927. Seventy per cent. of these cases were found to be fit after six or more years, and six out of a total of eight deaths which had occurred after discharge were of patients who had been removed from hospital against advice. Dr. T. W. Davies presents a study of the association of pulmonary and non-pulmonary conditions in the same patients; and Dr. W. Davies describes a case of tuberculous pericarditis with effusion, which was treated with some success by aspiration followed by air replacement of the fluid withdrawn. Over 3,000 contacts, were examined during the year by the medical staff of the Association, and an interesting table giving the results of contact examinations in Wales, compared with similar figures obtained from Lancashire, quoted from Dr. MacNalty's Report on Tuberculosis, shows that tuberculosis is found twice as often amongst contacts in Wales as in Lancashire, and taking adults alone it is found two-and-a-half times as often. The area physicians do n o t unanimously approve contact examination as a method of discovering cases of tuberculosis, but Dr. Howell Williams describes some striking results in this direction, obtained by the examination of contacts of seven cases in his area. In conjunction with the research department of the Association, work has been carried out in connection with " contacts," into certain " curious " bodies found in the lungs of colliers, coal trimmers and others, and in regard to tuberculin tests in a mental hospital ; whilst Prof. Cummins has pursued his study of the value of gold salts in the treatment of pulmonary tuberculosis, and his search for methods to evaluate their effects. In t h e Association?s central laboratory, under the direction of Dr. W. H. Tytler; an increased amount of routine work has been done, and it is interesting to note that from a study of the bacillary types cultured from 450 cases treated by the staff of the Association, not more than 8 per cent. were found to be of bovine origin. T h o u g h t h e amount of bovine infection amongst human cases appears to be comparatively low in Wales, the Association has taken active measures to encourage the establishment of tubercle-free herds and improve the quality of milk generally, and a joint committee representing the Royal Welsh Agricultural Society
1934.
PUBLIC HEALTH.
and the Association has been set up with this object in view. The educational work of the Association has been vigorously carried on during t h e year. Dr. Owen Morris, the Director of Education, is described as having addressed with apostolic fervour, as many meetings as would tax a Chrysostom ; and the two lady lecturers have given addresses on " Tuberculosis and the Laws of Health " and " Infant Care " (to senior girls) on 1,t75 occasions. The reports of the superintendents of institutions and area physicians show ample evidence of the appreciation of the work of the Association by the public, and of harmonious co-operation with medical practitioners, whilst the numerical preponderance of public health officers on the medical committee of the Association assures that the claims of preventive medicine shall not be overlooked.
121
Tuberculosis again furnished a new low record of 837 per million living. Puerperal sepsis caused the deaths of 1.55 Women per 1,000 live and still births--0.04 less than the rate for 1931, and 0.29 less than 1930. " Other accidents of pregnancy and childbirth " showed a rate of 2.49 per 1,000 live and still births, compared with 2.36 in 1931. The death-rate from suicide was 143 per million persons living, a new high record, the rate for 1931 (the previous highest) being 129. A slow increase in this rate has been continuous for a number of years. Road accidents due to mechanical vehicles were responsible for 5,671 deaths. The figures for the last five years were 4,452, 5,196, 5,752, 6,342 and 5,892 respectively. The volume, which is on sale at H.M. Stationer3; Office, price 6s. net, is one to which reference at intervals by every medical officer of health throughout the year is inevitable.
The Statistical Review of 1932.
p
ART I of the Registrar-General's Statistical Review of England and Wales for the year 1932, containing the medical tables, recently issued, calls for reference here. From the tables relating to births, it is gathered that the number registered in the year was 613,972, giving a rate of 15"3 per 1,000 persons living. This rate is 0.5 below that for 193t, hitherto the lowest on record, and constitutes a new low record. The death-rate was 12.0 per 1,000 persons living, being 0.3 below the rate for 1931, but 0.6 above that for 1930. The rate for 1930 was, however, the lowest ever recorded, and was largely due to the exceptionally mild weather in the first quarter of that year. The higher rate for 1932 is almost wholly occasioned by an excess in the first quarter of the year, the rates for the other three quarters showing very little variation. Infant mortality was similarly affected, and the deaths of children under one year of age numbered 65 per 1,000 live births, against 66 in 1931, and 60 in 1930. 1930 is, however, the only year showing a lower infant mortality than 1932. Cancer showed a death-rate of 1,510 per milion persons living, against 1,484 in 1931. if, however, allowance is made for diffcrences in the age constitution of the population, the comparative mortality from cancer showg a much smaller increase.
After-Histories of Tuberculous Patients. N a special report bearing the title " ResidenI tial Treatment of Tuberculosis : AfterHistories of Patients Discharged during 1921," Sir Frederick Menzies, Medical Officer of Health of the London County Council, reviews the condition in 1931 of 4,160 tuberculous patients (3,528 adults and 632 children) ten years subsequent to their discharge from hospitals and sanatoria during the year 1921. At the end of the ten years, 837 (512 adults and 325 children) were known to be alive; 2,340 (2,193 adults and 147 children) were reported dead, and 983 (823 adults and 160 children) were untraced. The somewhat high proportion of untraced (23 per cent.) introduces a considerable measure of error into the statistics, which must, therefore, be considered as representing a general survey rather than an actuarial study. It is to be noted that the figures for t h e " unt r a c e d " include many patients who were removed frcm the tut:erculosis dispensary registers as " recovered cases," in accordance with the regulaticns ef the Ministry of Health. There is good reason to believe that the greater number of these recovered cases are alive and in good health, and that the number of patients surviving after ten years is, therefore appreciably higher than 837. The various tables show that for the traced cases the mortality of the various types of