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TUBERCULOSIS AND THE NORTHAMPTON BOOT TRADE.
THE ANNUS MEDIOUS 1906.
1818
catchment ground. It is proposed to 30 acres more and to build other reservoirs or to use a part of the tunnel as a reservoir and thus to create space for the storage of 17,000,000 gallons of pure rain water. The actual storage of 5,000,000 gallons suffices unless there is a very dry season, but with 17,000,000 gallons Gibraltar will be safe against all emergencies and will be able to do away with the less safe practice of gathering water on the roofs of the houses. Already typhoid fever, which used to be very prevalent, has almost entirely disappeared, and the deaths from infectious disease have been reduced by about 50 per cent. during,the last 20 years. The sanitary commissioners and their engineer, Mr. W. W, COPLAND, were warmly congratulated on the successful piercing of the tunnel and their remarkable scheme. The only inhabitants of the"Rock"who are not pleased are the monkeys and they have shown their dissatisfaction in a very troublesome manner. They arm themselves with large stones, climb to some vantage ground, and then hurl their missiles down on to the corrugated iron with such force that they pierce holes in this catchment and a considerable portion of the water escapes into the sand underneath. iron and
serve as a
cover over
TEMPERANCE LEGISLATION IN FRANCE. heading a series of exhaustive articles
Under this
what
were
have been adopted in France to check the spread of alcoholism and drunkenness. The French make a marked difference between these two terms, looking upon drunkenness as a minor. evil, while alcoholism is considered as equivalent to the destruction of the human race. Then comes the apparently strange assertion that a man who has never been drunk may become the victim of alcoholism while another who does occasionally get drunk may live to a ripe old age and be perfectly free from the taint of alcoholism. Instead of wildly denouncing every form of beverage containing alcohol, as is the wont of the teetotal advocate, the French Legislature, inspired by the debates of the international congresses of hygiene, have made wise discriminations. At Budapest, in 1894, the International Congress of Hygiene advocated the augmentation of taxation on spirits and the reduction of taxes on beer and wine. Where spirits are distilled these should be under the strictest Government control or, better still, they should constitute a Government monopoly, as in Russia and Switzerland. It is the separation of alcohol from that which produces alcohol which is particularly dangerous, while, on the other hand, the alcohol which results from the natural process of the fermentation of a fruit juice or of wholesome barley and hops might intoxicate but was not likely to produce the disease known as alcoholism. This is no theory but a geographical fact. A glance at the map suffices to show that all the countries where drunkenness and alcoholism are practically unknown are wine-producing countries. Hence the term "hygienic drinks"arose as applied to those beverages where the alcohol is not separated, extracted, or distilled from the liquid in which it is formed-namely, the juice of grapes, apples, pears, barley and hops, or honey. In that case the amount of alcohol is very small-from 2 per cent. for the weakest cider to about 14 per cent. in the stronger among the light natural clarets. In this beer is included, on the condition that it is made only from barley, hops, yeast, and water. The Bavarian law for 500 years has rendered it a criminal offence to add any other substance whatsoever to beer. Hence, Munich beer holds a forefront rank among the hygienic drinks. Now that France, by the utilisation of American plants, has completely recovered from the disastrous effects of the phylloxera, wine is produced in such abundance that it is essentially the poor man’s drink and should replace all the
published showing
measures
unwholesome and more expensive spirits that poison entire There was, however, one obstacle in the way; is so cheap the taxes were high. In Paris the ootroi or town dues levied on wine amounted to no less than 10 francs 62 centimes the hectolitre. In the provincial towns it was less but still very high. The French Parliament, impressed with the fact that with the prevalence of the phylloxera and the consequent dearness of wine, drunkenness had increased and that all experience proved that cheap wine was the most practical means of promoting temperance, passed a law restricting the right of towns and rural communes to tax hygienic drinks. The highest octroi is not to be more than 2 francs 25 centimes the hectolitre for towns above 50,000 inhabitants and 4 francs for Paris. In smaller towns the tax must be much less. But Paris, not to be outdone by the Parliament, altogether abolished the octroi on hygienic drinks. This was a heroic measure, for it meant the sacrifice of a third of the annual revenue derived from the octroi-namely, £2,290,000 out of about £6,200,000. How this great loss of revenue for the purposes of local government was replaced by other taxes was fully explained. The octroi on spirits, which are the principal cause of alcoholism, was doubled. The State increased the general tax on spirits from 156 francs 25 centimes to 222 francs the hectolitre and as the Paris octroi is now doubled the State and the local tax paid on spirits drunk in Paris actually amounts to 415 francs or .,16 12s. the hectolitre or 22 gallons. In England the tax on spirits is only E13 the hectolitre, while in Russia it is £20. The result of all this legislation is that excellent sound wine is now retailed in Paris at from 2d. to 3d. per litre. Thus wine is drunk in Paris at, in round figures, Id. per pint or lid. per bottle. Of such wine samples were analysed in our laboratory and were found to be absolutely pure and wholesome. In England the Custom duty is 32d. per litre ; thus the duty charged is about double the If to this be added the wholesale cost of the wine. wine can be and obtained in London at 7d. freight bottling, and be from 8d. to 10d. per litre litre should retailed at per to The position in England is about the according quality. same as that of France during the worst days of the phylloxera, when alcoholism increased to so alarming an extent that the Senate instituted a special inquiry into the The reports which we published on this matter deal also with the possibility of utilising in England the experience now being acquired in France by the policy of cheapen" ing the cost of hygienic drinks."
populations. though wine
evil.
TUBERCULOSIS AND THE NORTHAMPTON BOOT TRADE. The question of sanatoriums was dealt with extensively during 1905, when the International Congress on Tuberculosis This year we dealt with some of the details was held. rather than generalisation. Thus we published a lengthy account of the special frequency of pulmonary tuberculosis among the boot- and shoe-makers of Northampton. The position is, as set forth by the latest statistics given, that the mortality from senile decay in England and Wales was 1-27 per 1000, but it was only 0-59 per 1000 at Northampton. Then in regard to tuberculosis, in 1903 the number of deaths from this disease, after the age of 15 years, was l’60 per 1000 in England and Wales; it was 1-82 at Northampton and 2’ 59 among those who at Northampton work in the boot and shoe trade. Going further into the details it was shown that among the closers and machinists the cases of tuberculosis amounted to l’44 and 119 deaths per 1000 per annum out of a total death-rate of 3-28 and 3 -C9 per 1000, though the general death-rate of the country for adults was 9.77 per 1000. This means that these workers, about 4000 women, do not remain long in this occupation. They marry or go into
THE ANNUS MEDIOUS 1906.
other business, but while they are engaged as closers by everyone concerned in local government. If the visit.of machinists in the boot trade there is an extraordinary the London County Councillors to Paris has served to and fatal prevalence of pulmonary tuberculosis among them. stimulate such investigations it will by the entente have To remedy this evil much more effective factory inspection done good service to the cause of international peace, and is needed, leading to the introduction of scientific mechanical by the municipal character of the entente it will have means of ventilation. Then a popular sanatorium and a hos- helped to promote good local government. should the means of preventing sufferers from pital provide frequenting the workshops where they are likely to conTHE BATTLE OF THE CLUBS. taminate their fellow workers. It did not seem, however, as but little has been published this year about the Though if the borough council of Northampton was fully alive to its of organisation the profession yet on no previous occasion has responsibilities. As usual in such cases, the council is terribly an account been given of a grievance so scandalously afraid of incurring any large expense and unable to grasp the derogatory to the dignity of the profession as that of the fact that effective measures, however expensive, prove in the battle of the clubs at Macclesfield. Here there are burial long run far cheaper than a mere tinkering. It is more clubs dating as far back as the year 1831 and 1833. Though extravagant to spend a small sum that yields no result than three-quarters of a century have elapsed there has been a large amount which confers widespread and unmistakable hardly any change in the payment made to the medical benefits. officers of these societies. On the other hand, the members expect much better attendance and this from VISIT OF THE LONDON COUNTY COUNCIL TO PARIS. qualified practitioners, whereas formerly they were content The return visit of the London County Council to the Paris with an unqualified assistant. But this is the case all over Municipality, following closely upon the visit of the former the kingdom. The difference is that in most parts of body to London, was primarily a manifestation of the entente the country 4s. or 4s. 4d. is considered the minimum paycordiale which has happily arisen between England and ment per member per annum which can be given to a club France. But if, as is undoubtedly the case, it leads to a medical officer. There are some places, however, where better knowledge in France as in England of what has only 3s. or 2s. 6d. are paid and this is considered a great proved beneficent in rpgard to local administration the result evil. But what can be said of Macclesfield where the will be doubly blessed. Undoubtedly London has much to medical officer of the General Burial Society receives learn from Paris and the Parisians themselves are the first only lOd. per year from each person whom he is bound to to acknowledge that, especially in regard to sanitation, attend in case of sickness’? The medical officer received they have profited by the many useful object lessons which last year .f.254 13s. 7d., or 61,123 pennies, and there London can give. It must be ccnfessed, however, as was were 6115 members, and this, it will be seen, amounts to explained at the time, that the intense anxiety manifested 10d. per member. In face of these figures the medical during the visit of the London County Councillors to Paris practitioners at Macclesfield raised the question whether it to promote the entente marred to some extent the qualifying was not "infamous in the professional sense" for a medical word municipale. There were so many fetes, receptions, to contract to attend professionally on members practitioner and excursions that little or no time remained to of a club whenever called if the remuneration given were only study technical administrative questions. The programme equal for each person to about three-quarters of a farthing was over-charged; everyone claimed the honour of a visit week. Are not such terms an insult to the profession ? from the London Councillors, so that they were not able to per Nevertheless when one of these burial societies recently remain long enough at any one’ point thoroughly to advertised for a medical officer it received 33 applications. investigate whatever might be of technical importance. The efforts made by the local practitioners to prevent the Nevertheless, they saw, if only superficially, many from the outside of medical officers willing to importation things that would or should have tempted individual receive only 10d. a year were related in these columns. councillors to return and to study quietly the problems the explanation of the possibility of one single Perhaps For instance, many schools were visited involved. practitioner having about 6000 club members on his but there was no time to investigate the details of the list is to be found in the fact that many of them administration of the cantines scolaires which provide midconsult him for trivial ailments. " Only a club day meals to all the children. Then the municipal slaughter- only doctor"is a phrase that has entered into the common house at La Villette was included in the programme, but of the population of Macclesfield ; and when somehere there was only time to drink a glass of champagne and parlance serious is the matter they endeavour to consult a practo make a few complimentary speeches without attempting thing titioner who is not a club medical officer. The fact that on to ascertain the measures taken to prevent the sale of these occasions they manage to pay the usual fees proves the unwholesome meat. The same may be said in regard to the amount of abuse that arises in club contract practice. University, the hospitals, the asylums, and many other great institutions also visited. There were also numerous other questions that the London County Councillors could have THE CHICAGO STOCKYARDS: THE UNITED STATES GOVERNMENT AND THE LANCET. advantageously studied but they were not approached this even in the most superficial manner. these Early year Mr. UPTON SINCLAIR brought out his Among may be mentioned the municipal bakery of the Rue Sipio book, "The Jungle." In the attractive form of a novel which provides uniform bread of excellent quality to all this work repeated the indictment of the Chicago stockthe hospitals. Then there is the organisation of the pari-yards made by our Special Sanitary Commissioner a year The fact that President ROOSEVELT was deeply mutuel by which no bet can be made on the racecourse] previously. 1 without contributing a part of the money to the relief iimpressed by "The Jungle"and caused investigations to of the poor, and the similar methods of taxing all be 1 made added greatly to the success of Mr. SINCLAIR’S occupied seats in theatres so that each pleasure-seekernovel. From the sanitary point of view, however, it would shall first pay something for those who are suffering from be 1 a mistake to imagine that nothing was done until after poverty or sickness. The erusiers sanitaires des maisons is the issue of this work of fiction. THE LANCET reports were i also a most valuable method of recording the sanitary history republished in Chicago shortly after their appearance in of every dwelling which will be of incalculable value in England. They occasioned much controversy and finally led t a radical reform in the method of inspection of meat by studying the incidence and distribution of disease. All these to and many other matters not mentioned should be investigated tthe local authority. This reform came into operation on some or
.
1819
____
.
1818
catchment ground. It is proposed to 30 acres more and to build other reservoirs or to use a part of the tunnel as a reservoir and thus to create space for the storage of 17,000,000 gallons of pure rain water. The actual storage of 5,000,000 gallons suffices unless there is a very dry season, but with 17,000,000 gallons Gibraltar will be safe against all emergencies and will be able to do away with the less safe practice of gathering water on the roofs of the houses. Already typhoid fever, which used to be very prevalent, has almost entirely disappeared, and the deaths from infectious disease have been reduced by about 50 per cent. during,the last 20 years. The sanitary commissioners and their engineer, Mr. W. W, COPLAND, were warmly congratulated on the successful piercing of the tunnel and their remarkable scheme. The only inhabitants of the"Rock"who are not pleased are the monkeys and they have shown their dissatisfaction in a very troublesome manner. They arm themselves with large stones, climb to some vantage ground, and then hurl their missiles down on to the corrugated iron with such force that they pierce holes in this catchment and a considerable portion of the water escapes into the sand underneath. iron and
serve as a
cover over
TEMPERANCE LEGISLATION IN FRANCE. heading a series of exhaustive articles
Under this
what
were
have been adopted in France to check the spread of alcoholism and drunkenness. The French make a marked difference between these two terms, looking upon drunkenness as a minor. evil, while alcoholism is considered as equivalent to the destruction of the human race. Then comes the apparently strange assertion that a man who has never been drunk may become the victim of alcoholism while another who does occasionally get drunk may live to a ripe old age and be perfectly free from the taint of alcoholism. Instead of wildly denouncing every form of beverage containing alcohol, as is the wont of the teetotal advocate, the French Legislature, inspired by the debates of the international congresses of hygiene, have made wise discriminations. At Budapest, in 1894, the International Congress of Hygiene advocated the augmentation of taxation on spirits and the reduction of taxes on beer and wine. Where spirits are distilled these should be under the strictest Government control or, better still, they should constitute a Government monopoly, as in Russia and Switzerland. It is the separation of alcohol from that which produces alcohol which is particularly dangerous, while, on the other hand, the alcohol which results from the natural process of the fermentation of a fruit juice or of wholesome barley and hops might intoxicate but was not likely to produce the disease known as alcoholism. This is no theory but a geographical fact. A glance at the map suffices to show that all the countries where drunkenness and alcoholism are practically unknown are wine-producing countries. Hence the term "hygienic drinks"arose as applied to those beverages where the alcohol is not separated, extracted, or distilled from the liquid in which it is formed-namely, the juice of grapes, apples, pears, barley and hops, or honey. In that case the amount of alcohol is very small-from 2 per cent. for the weakest cider to about 14 per cent. in the stronger among the light natural clarets. In this beer is included, on the condition that it is made only from barley, hops, yeast, and water. The Bavarian law for 500 years has rendered it a criminal offence to add any other substance whatsoever to beer. Hence, Munich beer holds a forefront rank among the hygienic drinks. Now that France, by the utilisation of American plants, has completely recovered from the disastrous effects of the phylloxera, wine is produced in such abundance that it is essentially the poor man’s drink and should replace all the
published showing
measures
unwholesome and more expensive spirits that poison entire There was, however, one obstacle in the way; is so cheap the taxes were high. In Paris the ootroi or town dues levied on wine amounted to no less than 10 francs 62 centimes the hectolitre. In the provincial towns it was less but still very high. The French Parliament, impressed with the fact that with the prevalence of the phylloxera and the consequent dearness of wine, drunkenness had increased and that all experience proved that cheap wine was the most practical means of promoting temperance, passed a law restricting the right of towns and rural communes to tax hygienic drinks. The highest octroi is not to be more than 2 francs 25 centimes the hectolitre for towns above 50,000 inhabitants and 4 francs for Paris. In smaller towns the tax must be much less. But Paris, not to be outdone by the Parliament, altogether abolished the octroi on hygienic drinks. This was a heroic measure, for it meant the sacrifice of a third of the annual revenue derived from the octroi-namely, £2,290,000 out of about £6,200,000. How this great loss of revenue for the purposes of local government was replaced by other taxes was fully explained. The octroi on spirits, which are the principal cause of alcoholism, was doubled. The State increased the general tax on spirits from 156 francs 25 centimes to 222 francs the hectolitre and as the Paris octroi is now doubled the State and the local tax paid on spirits drunk in Paris actually amounts to 415 francs or .,16 12s. the hectolitre or 22 gallons. In England the tax on spirits is only E13 the hectolitre, while in Russia it is £20. The result of all this legislation is that excellent sound wine is now retailed in Paris at from 2d. to 3d. per litre. Thus wine is drunk in Paris at, in round figures, Id. per pint or lid. per bottle. Of such wine samples were analysed in our laboratory and were found to be absolutely pure and wholesome. In England the Custom duty is 32d. per litre ; thus the duty charged is about double the If to this be added the wholesale cost of the wine. wine can be and obtained in London at 7d. freight bottling, and be from 8d. to 10d. per litre litre should retailed at per to The position in England is about the according quality. same as that of France during the worst days of the phylloxera, when alcoholism increased to so alarming an extent that the Senate instituted a special inquiry into the The reports which we published on this matter deal also with the possibility of utilising in England the experience now being acquired in France by the policy of cheapen" ing the cost of hygienic drinks."
populations. though wine
evil.
TUBERCULOSIS AND THE NORTHAMPTON BOOT TRADE. The question of sanatoriums was dealt with extensively during 1905, when the International Congress on Tuberculosis This year we dealt with some of the details was held. rather than generalisation. Thus we published a lengthy account of the special frequency of pulmonary tuberculosis among the boot- and shoe-makers of Northampton. The position is, as set forth by the latest statistics given, that the mortality from senile decay in England and Wales was 1-27 per 1000, but it was only 0-59 per 1000 at Northampton. Then in regard to tuberculosis, in 1903 the number of deaths from this disease, after the age of 15 years, was l’60 per 1000 in England and Wales; it was 1-82 at Northampton and 2’ 59 among those who at Northampton work in the boot and shoe trade. Going further into the details it was shown that among the closers and machinists the cases of tuberculosis amounted to l’44 and 119 deaths per 1000 per annum out of a total death-rate of 3-28 and 3 -C9 per 1000, though the general death-rate of the country for adults was 9.77 per 1000. This means that these workers, about 4000 women, do not remain long in this occupation. They marry or go into
THE ANNUS MEDIOUS 1906.
other business, but while they are engaged as closers by everyone concerned in local government. If the visit.of machinists in the boot trade there is an extraordinary the London County Councillors to Paris has served to and fatal prevalence of pulmonary tuberculosis among them. stimulate such investigations it will by the entente have To remedy this evil much more effective factory inspection done good service to the cause of international peace, and is needed, leading to the introduction of scientific mechanical by the municipal character of the entente it will have means of ventilation. Then a popular sanatorium and a hos- helped to promote good local government. should the means of preventing sufferers from pital provide frequenting the workshops where they are likely to conTHE BATTLE OF THE CLUBS. taminate their fellow workers. It did not seem, however, as but little has been published this year about the Though if the borough council of Northampton was fully alive to its of organisation the profession yet on no previous occasion has responsibilities. As usual in such cases, the council is terribly an account been given of a grievance so scandalously afraid of incurring any large expense and unable to grasp the derogatory to the dignity of the profession as that of the fact that effective measures, however expensive, prove in the battle of the clubs at Macclesfield. Here there are burial long run far cheaper than a mere tinkering. It is more clubs dating as far back as the year 1831 and 1833. Though extravagant to spend a small sum that yields no result than three-quarters of a century have elapsed there has been a large amount which confers widespread and unmistakable hardly any change in the payment made to the medical benefits. officers of these societies. On the other hand, the members expect much better attendance and this from VISIT OF THE LONDON COUNTY COUNCIL TO PARIS. qualified practitioners, whereas formerly they were content The return visit of the London County Council to the Paris with an unqualified assistant. But this is the case all over Municipality, following closely upon the visit of the former the kingdom. The difference is that in most parts of body to London, was primarily a manifestation of the entente the country 4s. or 4s. 4d. is considered the minimum paycordiale which has happily arisen between England and ment per member per annum which can be given to a club France. But if, as is undoubtedly the case, it leads to a medical officer. There are some places, however, where better knowledge in France as in England of what has only 3s. or 2s. 6d. are paid and this is considered a great proved beneficent in rpgard to local administration the result evil. But what can be said of Macclesfield where the will be doubly blessed. Undoubtedly London has much to medical officer of the General Burial Society receives learn from Paris and the Parisians themselves are the first only lOd. per year from each person whom he is bound to to acknowledge that, especially in regard to sanitation, attend in case of sickness’? The medical officer received they have profited by the many useful object lessons which last year .f.254 13s. 7d., or 61,123 pennies, and there London can give. It must be ccnfessed, however, as was were 6115 members, and this, it will be seen, amounts to explained at the time, that the intense anxiety manifested 10d. per member. In face of these figures the medical during the visit of the London County Councillors to Paris practitioners at Macclesfield raised the question whether it to promote the entente marred to some extent the qualifying was not "infamous in the professional sense" for a medical word municipale. There were so many fetes, receptions, to contract to attend professionally on members practitioner and excursions that little or no time remained to of a club whenever called if the remuneration given were only study technical administrative questions. The programme equal for each person to about three-quarters of a farthing was over-charged; everyone claimed the honour of a visit week. Are not such terms an insult to the profession ? from the London Councillors, so that they were not able to per Nevertheless when one of these burial societies recently remain long enough at any one’ point thoroughly to advertised for a medical officer it received 33 applications. investigate whatever might be of technical importance. The efforts made by the local practitioners to prevent the Nevertheless, they saw, if only superficially, many from the outside of medical officers willing to importation things that would or should have tempted individual receive only 10d. a year were related in these columns. councillors to return and to study quietly the problems the explanation of the possibility of one single Perhaps For instance, many schools were visited involved. practitioner having about 6000 club members on his but there was no time to investigate the details of the list is to be found in the fact that many of them administration of the cantines scolaires which provide midconsult him for trivial ailments. " Only a club day meals to all the children. Then the municipal slaughter- only doctor"is a phrase that has entered into the common house at La Villette was included in the programme, but of the population of Macclesfield ; and when somehere there was only time to drink a glass of champagne and parlance serious is the matter they endeavour to consult a practo make a few complimentary speeches without attempting thing titioner who is not a club medical officer. The fact that on to ascertain the measures taken to prevent the sale of these occasions they manage to pay the usual fees proves the unwholesome meat. The same may be said in regard to the amount of abuse that arises in club contract practice. University, the hospitals, the asylums, and many other great institutions also visited. There were also numerous other questions that the London County Councillors could have THE CHICAGO STOCKYARDS: THE UNITED STATES GOVERNMENT AND THE LANCET. advantageously studied but they were not approached this even in the most superficial manner. these Early year Mr. UPTON SINCLAIR brought out his Among may be mentioned the municipal bakery of the Rue Sipio book, "The Jungle." In the attractive form of a novel which provides uniform bread of excellent quality to all this work repeated the indictment of the Chicago stockthe hospitals. Then there is the organisation of the pari-yards made by our Special Sanitary Commissioner a year The fact that President ROOSEVELT was deeply mutuel by which no bet can be made on the racecourse] previously. 1 without contributing a part of the money to the relief iimpressed by "The Jungle"and caused investigations to of the poor, and the similar methods of taxing all be 1 made added greatly to the success of Mr. SINCLAIR’S occupied seats in theatres so that each pleasure-seekernovel. From the sanitary point of view, however, it would shall first pay something for those who are suffering from be 1 a mistake to imagine that nothing was done until after poverty or sickness. The erusiers sanitaires des maisons is the issue of this work of fiction. THE LANCET reports were i also a most valuable method of recording the sanitary history republished in Chicago shortly after their appearance in of every dwelling which will be of incalculable value in England. They occasioned much controversy and finally led t a radical reform in the method of inspection of meat by studying the incidence and distribution of disease. All these to and many other matters not mentioned should be investigated tthe local authority. This reform came into operation on some or
.
1819
____
.