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THOUGHTFUL GRATITUDE.
523
PUBLIC HEALTH SERVICES.
THE PREVENTION OF INFLUENZA. To the Editor of THE LANCET. SIR,—Last week you gave a useful resume of how best to avoid and deal with attacks of this infectious One pitfall which might disease now prevalent. have been mentioned has lately been fully discussed the danger of washGrant--namely, by Dr. Lachlan " " water in the ordinary washing in stationary hand and lavatory basins. As these basins are used
by everybody, healthy
or
sterilised after use, they
unhealthy, and
are
cannot be bound to harbour infec-
micro-organisms and
thus favour a spread of Dr. Grant’s remedy is to fit all such basins with a raised tap, having a rose wave or jet outlet, removed some distance from the sides of the basin so as to prevent the hands coming into contact with its contaminated walls. By this device ablutions are performed in pure fresh water, all infective particles being conveyed direct to the soil I am, Sir, yours faithfully, pipe. RITA C. WEIR, M.B. Glasg. Bacteriological Laboratory, Ballachulish, Argyleshire, March 3rd, 1929. tive
infectious diseases.
AGRANULOCYTIC ANGINA. To the Editor
THE LANCET. a case in your last a condition which, if not actually so infrequent as some think, is at least He suggests that further very seldom diagnosed. work should be done with regard to arriving at the aetiology of the condition and to finding some method of treating it. In Germany some good results have been obtained by the application of X rays (in mild doses) to the long bones with a view to stimulating the output of leucocytes. A few cases were treated thus with I saw two success in Berlin in the summer of 1927. cases of agranulocytic angina treated in this way by Eppinger, of Freiburg ; one was a nurse, but she was almost moribund before the treatment was tried and died shortly afterwards ; the other, a woman of 42, made quite a remarkable recovery, although her white count was very low before the institution of the treatment (800 per c.mm.) Eppinger showed this case later at a meeting of the Freiburg Medizinische I am, Sir, yours faithfully, Gesellschaft. P. J. MOLLOY. Cricklewood, March 5th, 1929.
of
SIR,—Dr. Batten’s report of issue (p. 440) draws attention to
THOUGHTFUL GRATITUDE. To the Editor of THE LANCET. SIR,—When a medical man who is in ill-health asks for the advice of a consultant and obtains it without any fee, how well it would be if it were an understood rule that he should send a cheque, according to his circumstances, to one of the medical charities, such as the Royal Medical Benevolent Fund or the British Medical Benevolent Society. A little more thoughtful gratitude on the part of the profession would vastly increase the well-known usefulness of those institutions. I am,
Sir, yours faithfully, JAMES G. MACASKIE, L.R.C.P. &
S. Edin.
Princes-Rama,rPs W. Ma.rrth 4th. ta9Q
** * The hon. treasurer of the Royal Medical Benevolent Fund is making a special appeal for financial help to the Fund at this time of year when poverty is made the harder to bear owing to illness and bodily suffering. Subscriptions are urgently needed to enable the committee to meet many calls which are made by members of our own profession, their widows and dependents, who are afflicted by poverty and want. Some have no friend or relation to whom they can turn and are dependent on this Fund alone. A number of cases which were relieved at the last meeting are described on p. 534. Subscriptions and donations may be sent to him at 11, Chandos-street, London, W.I.—ED. L.
Public Health Services. INFLUENZA. CLINICAL reports indicate that the epidemic is still very widespread, although in most places remaining mild in form. Numerous cases of pneumonia are occurring in Leeds, but there is some doubt whether the majority of these are secondary to influenza or primary. Sheffield reports a widespread but mild epidemic of influenza, and in Leicester town and county a severe type of the disease is reported and a rather severe type also in Northamptonshire. Reports from Birmingham and North Staffordshire suggest that the disease is on the increase and the epidemic does not appear yet to have reached its peak in the Midlands generally. The disease is still very prevalent in Manchester and other Lancashire towns, as well as in Newcastle-on-Tyne and the North, but in Liverpool it is decreasing rapidly. The Eastern counties are also affected. A mild form of the disease is reported from South Wales, while North Wales and Gloucester are stated to be free. In Scotland, during the week ended March 2nd, the aggregate death-rate for the 16 towns was 19-1, that for Aberdeen being 30°2, Glasgow 17°8, Edinburgh 21-4, and Dundee 19-9. Deaths from influenza and respiratory diseases numbered 67 and 213 respectively and 298 cases of pneumonia were notified. On the Continent a marked increase in the number of deaths occurred in the Rhine districts as far south as Mannheim, which had so far been unaffected by the epidemic. Thus the death-rate of Mannheim rose in a single week from 11-5 to 23-2 per 1000 inhabitants, that of Dortmund from 14-2 to 21-0. In the Netherlands the epidemic is causing some difficulty in the public services. The town most severely affected is Arnhem, near the German frontier, where the death-rate rose to 43-9 per 1000 during the week ended Feb. 22nd. In Paris during the first ten days of February influenza deaths were numerous, the general death-rate rising to 28-7 ; there was a similar increase at Lille, and the epidemic extended as far south as Lyons, where a death-rate of 32-6 was registered during the week ended Feb. 20th. The Italian Health Service reports a spread of influenza, particularly in the provinces of Northern and Central Italy. The prevailing type remains mild and complications are rare. An increased mortality has been observed as far east as Budapest, but Warsaw has as yet not been affected. The epidemic is generally abating in the Scandinavian countries. In Spain the reports of Feb. 18th show an all-round decrease. Switzerland has had the disease only in mild form ; up to Feb. 9th the general mortality was very low for the season of the year. In parts of Czecho-Slovakia influenza is increasing. The epidemic in the United States of America is now virtually at an end. ----
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED FEB. 23RD, 1929.
Notifications.-The following cases of infectious disease were notified during the week :-Small-pox, 275 ; scarlet fever, 2150 ; diphtheria, 1098 ; enteric fever, 30 ; pneumonia, 4451 (last week 3658) ; puerperal fever, 43 ; puerperal pyrexia, 150 ; cerebrospinal fever, 16 ; acute poliomyelitis, 4 ; encephalitis
lethargica, 21 ; dysentery, 9 ; ophthalmia neonatorum, 83. No case of cholera, plague, or typhus fever was notified during the week. Notifications of pneumonia have again risen considerably after a drop last week, the figures for the last six weeks being 1936, 1864, 2422, 3511, 3898, and 3658 respectively. Counties reporting a large number of cases of pneumonia are as follows : London 554 (last week 562) ; Chester, 155 (173) ; Derby, 53 (64) ; Devon, 47 (38) ; Durham, 244 (168) ; Essex, 128 (167; Kent, 92 (74) ; Lancaster, 783 (906) Leicester, 52 (42) ; Middlesex, 189 (150) ; 167 (100) ; Stafford, 209 (113) ; Surrey, 78 (69) ; Warwick,
Northumberland,
.
PUBLIC HEALTH SERVICES.
THE PREVENTION OF INFLUENZA. To the Editor of THE LANCET. SIR,—Last week you gave a useful resume of how best to avoid and deal with attacks of this infectious One pitfall which might disease now prevalent. have been mentioned has lately been fully discussed the danger of washGrant--namely, by Dr. Lachlan " " water in the ordinary washing in stationary hand and lavatory basins. As these basins are used
by everybody, healthy
or
sterilised after use, they
unhealthy, and
are
cannot be bound to harbour infec-
micro-organisms and
thus favour a spread of Dr. Grant’s remedy is to fit all such basins with a raised tap, having a rose wave or jet outlet, removed some distance from the sides of the basin so as to prevent the hands coming into contact with its contaminated walls. By this device ablutions are performed in pure fresh water, all infective particles being conveyed direct to the soil I am, Sir, yours faithfully, pipe. RITA C. WEIR, M.B. Glasg. Bacteriological Laboratory, Ballachulish, Argyleshire, March 3rd, 1929. tive
infectious diseases.
AGRANULOCYTIC ANGINA. To the Editor
THE LANCET. a case in your last a condition which, if not actually so infrequent as some think, is at least He suggests that further very seldom diagnosed. work should be done with regard to arriving at the aetiology of the condition and to finding some method of treating it. In Germany some good results have been obtained by the application of X rays (in mild doses) to the long bones with a view to stimulating the output of leucocytes. A few cases were treated thus with I saw two success in Berlin in the summer of 1927. cases of agranulocytic angina treated in this way by Eppinger, of Freiburg ; one was a nurse, but she was almost moribund before the treatment was tried and died shortly afterwards ; the other, a woman of 42, made quite a remarkable recovery, although her white count was very low before the institution of the treatment (800 per c.mm.) Eppinger showed this case later at a meeting of the Freiburg Medizinische I am, Sir, yours faithfully, Gesellschaft. P. J. MOLLOY. Cricklewood, March 5th, 1929.
of
SIR,—Dr. Batten’s report of issue (p. 440) draws attention to
THOUGHTFUL GRATITUDE. To the Editor of THE LANCET. SIR,—When a medical man who is in ill-health asks for the advice of a consultant and obtains it without any fee, how well it would be if it were an understood rule that he should send a cheque, according to his circumstances, to one of the medical charities, such as the Royal Medical Benevolent Fund or the British Medical Benevolent Society. A little more thoughtful gratitude on the part of the profession would vastly increase the well-known usefulness of those institutions. I am,
Sir, yours faithfully, JAMES G. MACASKIE, L.R.C.P. &
S. Edin.
Princes-Rama,rPs W. Ma.rrth 4th. ta9Q
** * The hon. treasurer of the Royal Medical Benevolent Fund is making a special appeal for financial help to the Fund at this time of year when poverty is made the harder to bear owing to illness and bodily suffering. Subscriptions are urgently needed to enable the committee to meet many calls which are made by members of our own profession, their widows and dependents, who are afflicted by poverty and want. Some have no friend or relation to whom they can turn and are dependent on this Fund alone. A number of cases which were relieved at the last meeting are described on p. 534. Subscriptions and donations may be sent to him at 11, Chandos-street, London, W.I.—ED. L.
Public Health Services. INFLUENZA. CLINICAL reports indicate that the epidemic is still very widespread, although in most places remaining mild in form. Numerous cases of pneumonia are occurring in Leeds, but there is some doubt whether the majority of these are secondary to influenza or primary. Sheffield reports a widespread but mild epidemic of influenza, and in Leicester town and county a severe type of the disease is reported and a rather severe type also in Northamptonshire. Reports from Birmingham and North Staffordshire suggest that the disease is on the increase and the epidemic does not appear yet to have reached its peak in the Midlands generally. The disease is still very prevalent in Manchester and other Lancashire towns, as well as in Newcastle-on-Tyne and the North, but in Liverpool it is decreasing rapidly. The Eastern counties are also affected. A mild form of the disease is reported from South Wales, while North Wales and Gloucester are stated to be free. In Scotland, during the week ended March 2nd, the aggregate death-rate for the 16 towns was 19-1, that for Aberdeen being 30°2, Glasgow 17°8, Edinburgh 21-4, and Dundee 19-9. Deaths from influenza and respiratory diseases numbered 67 and 213 respectively and 298 cases of pneumonia were notified. On the Continent a marked increase in the number of deaths occurred in the Rhine districts as far south as Mannheim, which had so far been unaffected by the epidemic. Thus the death-rate of Mannheim rose in a single week from 11-5 to 23-2 per 1000 inhabitants, that of Dortmund from 14-2 to 21-0. In the Netherlands the epidemic is causing some difficulty in the public services. The town most severely affected is Arnhem, near the German frontier, where the death-rate rose to 43-9 per 1000 during the week ended Feb. 22nd. In Paris during the first ten days of February influenza deaths were numerous, the general death-rate rising to 28-7 ; there was a similar increase at Lille, and the epidemic extended as far south as Lyons, where a death-rate of 32-6 was registered during the week ended Feb. 20th. The Italian Health Service reports a spread of influenza, particularly in the provinces of Northern and Central Italy. The prevailing type remains mild and complications are rare. An increased mortality has been observed as far east as Budapest, but Warsaw has as yet not been affected. The epidemic is generally abating in the Scandinavian countries. In Spain the reports of Feb. 18th show an all-round decrease. Switzerland has had the disease only in mild form ; up to Feb. 9th the general mortality was very low for the season of the year. In parts of Czecho-Slovakia influenza is increasing. The epidemic in the United States of America is now virtually at an end. ----
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED FEB. 23RD, 1929.
Notifications.-The following cases of infectious disease were notified during the week :-Small-pox, 275 ; scarlet fever, 2150 ; diphtheria, 1098 ; enteric fever, 30 ; pneumonia, 4451 (last week 3658) ; puerperal fever, 43 ; puerperal pyrexia, 150 ; cerebrospinal fever, 16 ; acute poliomyelitis, 4 ; encephalitis
lethargica, 21 ; dysentery, 9 ; ophthalmia neonatorum, 83. No case of cholera, plague, or typhus fever was notified during the week. Notifications of pneumonia have again risen considerably after a drop last week, the figures for the last six weeks being 1936, 1864, 2422, 3511, 3898, and 3658 respectively. Counties reporting a large number of cases of pneumonia are as follows : London 554 (last week 562) ; Chester, 155 (173) ; Derby, 53 (64) ; Devon, 47 (38) ; Durham, 244 (168) ; Essex, 128 (167; Kent, 92 (74) ; Lancaster, 783 (906) Leicester, 52 (42) ; Middlesex, 189 (150) ; 167 (100) ; Stafford, 209 (113) ; Surrey, 78 (69) ; Warwick,
Northumberland,
.