- Email: [email protected]
UNITED STATES OF AMERICA
571 not but
only straining its financial resources to the utmost they were calling for unreasonable services from
doctors and nuises. The difficulties to which Sir James referred are having close attention from the managers of all big voluntary hospitals in Scotland, for they are all faced with an increased demand on their services and hence with an increased financial strain. The
difficulty experienced in obtaining enough applicants for the nursing profession, combined with the efforts to shorten the nurses’ hours of duty, add considerably to these trials. PAYMENT BY PATIENTS
continues to take the lead in attempting obtain payment from hospital patients-not, however, without some opposition as became evident at the annual meeting of subscribers of the Victoria Infirmary, Glasgow, last week, when the nomination of the honorary treasurer for a seat on the board of management was defeated by a candidate who was nominated from the body of the room. The meeting was evidently a very crowded one and the allegation was made that the treasurer’s defeat was due to a "packed" vote. During the meeting a workers’ representative pointed out that 14,000 had been provided during the year by workers’ organisations ; he objected to anything in the nature of a means test and maintained that anyone who was eligible for National Health Insurance should be eligible for the Victoria Infirmary without such a test.
Glasgow
to
DEADLOCK AT DUNDEE
The trouble about the proposed alterations in the chair of midwifery in Dundee, to which I referred on Feb. 12th, has not been lessened by a conference held last week between representatives of the Dundee corporation, Dundee Royal Infirmary, and the university court of St. Andrews. The difficulty has apparently arisen out of the failure of the University and the directors of the Infirmary to agree about an appointment to the hitherto associated posts of professor of midwifery and visiting obstetrician and gynaecologist at the Infirmary. Lord McGregor Mitchell, rector of the University, said that from the point of view of the students it could not be denied that in the Dundée Royal Infirmary they had an up-to-date and well-equipped institution most suitable for teaching and that they had as lecturer a lady whose skill and wide knowledge were unequalled north of the Forth. The chairman of the directors of the Infirmary stated that the directors are not opposed to the establishment of the Maryfield unit ; but the transference of the chair of midwifery to the maternity hospital at Maryfield, with consequent development of its maternity department, could be achieved only at the expense of the existing services provided by the Infirmary. The directors suggest that there is no room in Dundee for two departments of midwifery and that any expansion should take place at the Infirmary where there is plenty of room for further building and where the running costs would be much lower. The proposed move would discourage subscription to their funds. There is always doubt as to what part a university should play in the appointment of staff to the teaching hospitals associated with it and the unfortunate conflict in Dundee has brought to light a situation which might well develop in any of the Scottish medical schools ; for the attitude of a university and of those who conduct the associated teaching hospitals are
by
no means
always identical.
UNITED STATES OF AMERICA
(FROM
OUR OWN
CORRESPONDENTS)
PREMATURE USE OF RABBIT SERUM
IN a letter written to you last summer I described the experiments being made with antipneumococcal rabbit serum. These experiments are still progressing hopefully, but premature publicity has brought the danger that a promising method may be discredited by too early adoption. To guard against this Dr. Edward S. Godfrey, Jr., health commissioner of the State of New York, has issued a statement deprecating any idea that the use of this new method of serum production will result shortly in the availability of serums highly effective in the treatment of all of the thirty different types of pneumococcus pneumonia. He finds it particularly unfortunate that the hope should be raised that a specific serum cure has been found for the prevalent and extremely serious type of pneumonia known as type III. There is as yet no conclusive evidence that this is so. At the same time the commissioner has made public a resolution adopted by his pneumonia advisory committee which bears on the question. The committee believe that the generalised use of antipneumococcus rabbit serum would be premature though in bactersemic patients severely sensitive to horse serum or for whom no horse serum is available, its use might be justified. Otherwise, however, they feel that application of this serum should be limited to clinical trial in a few selected hospitals until the value, safety, and limitations of the method are more
defined. This cautious attitude gets support from a report (published in the New York State Journzccb of ]ÿledicint3 of Feb. 15th, p. 245) from the Hospital of the Rockefeller Institute for Medical Research on the treatment of 67 cases of lobar pneumonia distributed among nine different types. In 13 cases of type III no evidence of the therapeutic effectiveness of type III antipneumococcus rabbit serum was demonstrated. The mortality-rate for the remaining cases treated with antipneumococcus rabbit serum of the homologous type was 3-7 per cent.
accurately
.
VITAL STATISTICS FOR
1937
The earlier reports of vital statistics for the last calendar year are arriving. The Metropolitan Insurance Company, always among the first to render an account, describes 1937 as " a star health year." Eight causes of death-typhoid fever, scarlet fever, tuberculosis, chronic nephritis, diseases arising out of pregnancy and childbirth, homicides, accidental burns, and railroad accidents-broke previous records for low mortality. The expectation of life at birth reached a new maximum of 60-7 years. The drop in pneumonia mortality despite an increase of deaths from influenza is significant. The alcoholism deathrate is the lowest since 1921. HEALTH
OF NEW YORK STATE
Dr. De Porte finds the health record of New York State for 1937 outstandingly favourable " and notes with especial satisfaction the levelling off or reversal of trends which in recent years have given rise to serious public concern. For the first time in ten years there has been an increase in the number of births. The infant mortality-rate (45) was lower than ever before ; the maternal mortality-rate (38 deaths per 10,000 total births) represents a reduction "
572 than 20 per cent. from that of the precedyear, which was in its turn the lowest on record. The death-rates from three of the important diseases of childhood-measles (0-4 per 100,000 population), scarlet fever (0-7), and diarrhoea and enteritis under 2 years (5’7)-were the lowest ever recorded, and the rates from diphtheria (0-6) and whooping-cough (1.3) were practically equal to the minimums of 1936. The sustained decline in the mortality from diphtheria is held to be a direct result of the application of scientifically proved methods of prevention and cure. In 1908 more than twenty thousand cases of diphtheria were reported in this State ; last year cases totalled only thirteen hundred. In 1908 there were 2468 deaths from diphtheria; last year only 80. No cases of the disease were recorded in 1937 in fortytwo of the sixty-eight Upstate cities and villages with over 10,000 population, and deaths were recorded in only six of these urban communities : Buffalo (2),
of
more
ing
Binghamton, Endicott, Lackawanna, Syracuse, Yonkers (1each). The total number of cases of reportable diseases, exclusive of syphilis and gonorrhcea, was considerably below the 1936 total, or the average for 1932-36. Compared with the preceding year there has been no increase in the combined number of deaths ascribed to diseases of the heart, blood-vessels, and kidneys. Although the upward movement of the cancer death-rate continued, the increase was, proportionately, the smallest in a decade. The rise in the tuberculosis death-rate in 1936 was only temporary, and the 1937 rate was the lowest in half a century. Finally, notwithstanding an increase in the mortality from diabetes, syphilis, and influenza, the total death-rate was, with one exception, the lowest in the history of the State Department of Health. A total of 640 cases of poliomyelitis were reported, more than three times the total for 1936 but considerably less than the annual average for the five-year period 1932-36.
scourge. The surveys showed overwhelming majorities in favour of government bureaux to distribute information, government treatment clinics, and a law requiring a test for venereal disease for all persons seeking marriage licences. There were smaller, but definite, majorities in favour of clinic treatment being free, and the punishment of known syphilitics who ignore the treatment provided for them. So far the federal government have not found the 25 million dollars which the surgeon-general estimates is necessary to finance an adequate programme of education and treatment, and the response to invitations to have a Wassermann done has been so immense that existing facilities for treatment have been swamped. This is natural as the organisation of clinics takes time, and pending the introduction of a federal scheme clinics are being provided on many different lines by local health authorities. Above the legend " No Longer Taboo " the Literary Digest of Jan. lst publishes a photograph showing a large crowd of young men and women with banners bearing the slogans " Chicago will Stamp out Syphilis," and " Friday the 13th is Unlucky for Syphilis." " The first step in the war against syphilis," says the caption, " was to bring the fight into the open. Over 1000 Chicago boys and girls in a helped city-wide campaign."
AUTOMOBILE ACCIDENT STATISTICS
The 1937 report of New York State’s Motor Vehicle Bureau is less cheerful. Since 1925 there have been well over a million automobile accidents in New York State, involving a death or personal injury, the number of deaths being 35,654. The motor vehicle accident experience for the year 1937 was one of the worst in the history of New York State. During this year there were 82,085 accidents in which 3065 persons were killed and 106,482 persons injured. SYPHILIS AND THE TABOO
Estimates of the incidence ofsyphilis in the United States range from 2 to 10 per cent. of the population, and the surgeon-general, Dr. Parran, believes that if certification were accurate syphilis would be found to be the chief cause of death. The enormous black population is a reservoir of infection that has no exact equivalent in Europe, for in the large towns, it is said, the average young male negro has a positive Wassermann. During 1937 there were signs that the country was awakening to the magnitude of this problem and that there was an increasing demand for drastic steps to check the disease, especially among young adults, who are most liable to attack. In various universities undergraduate papers started campaigns for compulsory Wassermann tests for incoming students, but at the University of Minnesota, where 7000 students were tested, only 6 positive reactions were found, and it seems that syphilis is The very rare among undergraduates generally. Institute of Public Opinion carried out a number of surveys during the year to discover how far the public were prepared to go in stamping out this
IRELAND (FROM OUR OWN CORRESPONDENT) THE DUBLIN HOSPITALS
IT is understood that the statement made in the the future of which mention was made in my last letter, although unauthorised is substantially correct. The various are to submit their soon as ready as hospitals plans to the Minister for approval, taking as their basis the recommendations in the report of the Hospital Commission. In the meantime a committee of the hospitals concerned is engaged, in consultation with a senior officer of the Minister’s staff, in working out a scheme for a central hospital bureau which will act as an admission bureau to the hospitals, and thereby get rid of the difficulties which, at present, often cause considerable embarrassment to both the patient who requires hospital treatment and his medical attendant. The decision of the Minister has given great satisfaction to the medical profession in Ireland, whose anxiety had been roused by a long period of suspense.
public press a fortnight ago in reference to development of the Dublin hospitals,
SIALOGRAPHY OF THE PAROTID SlALOGBAPHY is the radiography of opaque substances injected into salivary glands. Writing in the Quaderni di Radiologia (1937, n.s. 2, 139) on its use in the diagnosis of diseases of the parotid. A. Magnoni says that he uses 40 per cent. lodopin for the purpose. As a contrast medium for salivary ducts this has the advantage over Lipiodol that it is much less viscid. He describes his particular technique in detail and illustrates his paper with sialograms from cases of epidemic parotitis, suppurative parotitis, parotid tumours, parotid lymphadenitis, chronic parotitis, and parotid calculus. In conditions such as a mixed parotid tumour or a parotid lymphadenitis, sialography is seldom of more than academic interest. Unfortunately Magnoni has not always been able to correlate the radiographic findings with accurate bacteriological and cytological information about the saliva, and this leaves some of the interpretations open to doubt.
only straining its financial resources to the utmost they were calling for unreasonable services from
doctors and nuises. The difficulties to which Sir James referred are having close attention from the managers of all big voluntary hospitals in Scotland, for they are all faced with an increased demand on their services and hence with an increased financial strain. The
difficulty experienced in obtaining enough applicants for the nursing profession, combined with the efforts to shorten the nurses’ hours of duty, add considerably to these trials. PAYMENT BY PATIENTS
continues to take the lead in attempting obtain payment from hospital patients-not, however, without some opposition as became evident at the annual meeting of subscribers of the Victoria Infirmary, Glasgow, last week, when the nomination of the honorary treasurer for a seat on the board of management was defeated by a candidate who was nominated from the body of the room. The meeting was evidently a very crowded one and the allegation was made that the treasurer’s defeat was due to a "packed" vote. During the meeting a workers’ representative pointed out that 14,000 had been provided during the year by workers’ organisations ; he objected to anything in the nature of a means test and maintained that anyone who was eligible for National Health Insurance should be eligible for the Victoria Infirmary without such a test.
Glasgow
to
DEADLOCK AT DUNDEE
The trouble about the proposed alterations in the chair of midwifery in Dundee, to which I referred on Feb. 12th, has not been lessened by a conference held last week between representatives of the Dundee corporation, Dundee Royal Infirmary, and the university court of St. Andrews. The difficulty has apparently arisen out of the failure of the University and the directors of the Infirmary to agree about an appointment to the hitherto associated posts of professor of midwifery and visiting obstetrician and gynaecologist at the Infirmary. Lord McGregor Mitchell, rector of the University, said that from the point of view of the students it could not be denied that in the Dundée Royal Infirmary they had an up-to-date and well-equipped institution most suitable for teaching and that they had as lecturer a lady whose skill and wide knowledge were unequalled north of the Forth. The chairman of the directors of the Infirmary stated that the directors are not opposed to the establishment of the Maryfield unit ; but the transference of the chair of midwifery to the maternity hospital at Maryfield, with consequent development of its maternity department, could be achieved only at the expense of the existing services provided by the Infirmary. The directors suggest that there is no room in Dundee for two departments of midwifery and that any expansion should take place at the Infirmary where there is plenty of room for further building and where the running costs would be much lower. The proposed move would discourage subscription to their funds. There is always doubt as to what part a university should play in the appointment of staff to the teaching hospitals associated with it and the unfortunate conflict in Dundee has brought to light a situation which might well develop in any of the Scottish medical schools ; for the attitude of a university and of those who conduct the associated teaching hospitals are
by
no means
always identical.
UNITED STATES OF AMERICA
(FROM
OUR OWN
CORRESPONDENTS)
PREMATURE USE OF RABBIT SERUM
IN a letter written to you last summer I described the experiments being made with antipneumococcal rabbit serum. These experiments are still progressing hopefully, but premature publicity has brought the danger that a promising method may be discredited by too early adoption. To guard against this Dr. Edward S. Godfrey, Jr., health commissioner of the State of New York, has issued a statement deprecating any idea that the use of this new method of serum production will result shortly in the availability of serums highly effective in the treatment of all of the thirty different types of pneumococcus pneumonia. He finds it particularly unfortunate that the hope should be raised that a specific serum cure has been found for the prevalent and extremely serious type of pneumonia known as type III. There is as yet no conclusive evidence that this is so. At the same time the commissioner has made public a resolution adopted by his pneumonia advisory committee which bears on the question. The committee believe that the generalised use of antipneumococcus rabbit serum would be premature though in bactersemic patients severely sensitive to horse serum or for whom no horse serum is available, its use might be justified. Otherwise, however, they feel that application of this serum should be limited to clinical trial in a few selected hospitals until the value, safety, and limitations of the method are more
defined. This cautious attitude gets support from a report (published in the New York State Journzccb of ]ÿledicint3 of Feb. 15th, p. 245) from the Hospital of the Rockefeller Institute for Medical Research on the treatment of 67 cases of lobar pneumonia distributed among nine different types. In 13 cases of type III no evidence of the therapeutic effectiveness of type III antipneumococcus rabbit serum was demonstrated. The mortality-rate for the remaining cases treated with antipneumococcus rabbit serum of the homologous type was 3-7 per cent.
accurately
.
VITAL STATISTICS FOR
1937
The earlier reports of vital statistics for the last calendar year are arriving. The Metropolitan Insurance Company, always among the first to render an account, describes 1937 as " a star health year." Eight causes of death-typhoid fever, scarlet fever, tuberculosis, chronic nephritis, diseases arising out of pregnancy and childbirth, homicides, accidental burns, and railroad accidents-broke previous records for low mortality. The expectation of life at birth reached a new maximum of 60-7 years. The drop in pneumonia mortality despite an increase of deaths from influenza is significant. The alcoholism deathrate is the lowest since 1921. HEALTH
OF NEW YORK STATE
Dr. De Porte finds the health record of New York State for 1937 outstandingly favourable " and notes with especial satisfaction the levelling off or reversal of trends which in recent years have given rise to serious public concern. For the first time in ten years there has been an increase in the number of births. The infant mortality-rate (45) was lower than ever before ; the maternal mortality-rate (38 deaths per 10,000 total births) represents a reduction "
572 than 20 per cent. from that of the precedyear, which was in its turn the lowest on record. The death-rates from three of the important diseases of childhood-measles (0-4 per 100,000 population), scarlet fever (0-7), and diarrhoea and enteritis under 2 years (5’7)-were the lowest ever recorded, and the rates from diphtheria (0-6) and whooping-cough (1.3) were practically equal to the minimums of 1936. The sustained decline in the mortality from diphtheria is held to be a direct result of the application of scientifically proved methods of prevention and cure. In 1908 more than twenty thousand cases of diphtheria were reported in this State ; last year cases totalled only thirteen hundred. In 1908 there were 2468 deaths from diphtheria; last year only 80. No cases of the disease were recorded in 1937 in fortytwo of the sixty-eight Upstate cities and villages with over 10,000 population, and deaths were recorded in only six of these urban communities : Buffalo (2),
of
more
ing
Binghamton, Endicott, Lackawanna, Syracuse, Yonkers (1each). The total number of cases of reportable diseases, exclusive of syphilis and gonorrhcea, was considerably below the 1936 total, or the average for 1932-36. Compared with the preceding year there has been no increase in the combined number of deaths ascribed to diseases of the heart, blood-vessels, and kidneys. Although the upward movement of the cancer death-rate continued, the increase was, proportionately, the smallest in a decade. The rise in the tuberculosis death-rate in 1936 was only temporary, and the 1937 rate was the lowest in half a century. Finally, notwithstanding an increase in the mortality from diabetes, syphilis, and influenza, the total death-rate was, with one exception, the lowest in the history of the State Department of Health. A total of 640 cases of poliomyelitis were reported, more than three times the total for 1936 but considerably less than the annual average for the five-year period 1932-36.
scourge. The surveys showed overwhelming majorities in favour of government bureaux to distribute information, government treatment clinics, and a law requiring a test for venereal disease for all persons seeking marriage licences. There were smaller, but definite, majorities in favour of clinic treatment being free, and the punishment of known syphilitics who ignore the treatment provided for them. So far the federal government have not found the 25 million dollars which the surgeon-general estimates is necessary to finance an adequate programme of education and treatment, and the response to invitations to have a Wassermann done has been so immense that existing facilities for treatment have been swamped. This is natural as the organisation of clinics takes time, and pending the introduction of a federal scheme clinics are being provided on many different lines by local health authorities. Above the legend " No Longer Taboo " the Literary Digest of Jan. lst publishes a photograph showing a large crowd of young men and women with banners bearing the slogans " Chicago will Stamp out Syphilis," and " Friday the 13th is Unlucky for Syphilis." " The first step in the war against syphilis," says the caption, " was to bring the fight into the open. Over 1000 Chicago boys and girls in a helped city-wide campaign."
AUTOMOBILE ACCIDENT STATISTICS
The 1937 report of New York State’s Motor Vehicle Bureau is less cheerful. Since 1925 there have been well over a million automobile accidents in New York State, involving a death or personal injury, the number of deaths being 35,654. The motor vehicle accident experience for the year 1937 was one of the worst in the history of New York State. During this year there were 82,085 accidents in which 3065 persons were killed and 106,482 persons injured. SYPHILIS AND THE TABOO
Estimates of the incidence ofsyphilis in the United States range from 2 to 10 per cent. of the population, and the surgeon-general, Dr. Parran, believes that if certification were accurate syphilis would be found to be the chief cause of death. The enormous black population is a reservoir of infection that has no exact equivalent in Europe, for in the large towns, it is said, the average young male negro has a positive Wassermann. During 1937 there were signs that the country was awakening to the magnitude of this problem and that there was an increasing demand for drastic steps to check the disease, especially among young adults, who are most liable to attack. In various universities undergraduate papers started campaigns for compulsory Wassermann tests for incoming students, but at the University of Minnesota, where 7000 students were tested, only 6 positive reactions were found, and it seems that syphilis is The very rare among undergraduates generally. Institute of Public Opinion carried out a number of surveys during the year to discover how far the public were prepared to go in stamping out this
IRELAND (FROM OUR OWN CORRESPONDENT) THE DUBLIN HOSPITALS
IT is understood that the statement made in the the future of which mention was made in my last letter, although unauthorised is substantially correct. The various are to submit their soon as ready as hospitals plans to the Minister for approval, taking as their basis the recommendations in the report of the Hospital Commission. In the meantime a committee of the hospitals concerned is engaged, in consultation with a senior officer of the Minister’s staff, in working out a scheme for a central hospital bureau which will act as an admission bureau to the hospitals, and thereby get rid of the difficulties which, at present, often cause considerable embarrassment to both the patient who requires hospital treatment and his medical attendant. The decision of the Minister has given great satisfaction to the medical profession in Ireland, whose anxiety had been roused by a long period of suspense.
public press a fortnight ago in reference to development of the Dublin hospitals,
SIALOGRAPHY OF THE PAROTID SlALOGBAPHY is the radiography of opaque substances injected into salivary glands. Writing in the Quaderni di Radiologia (1937, n.s. 2, 139) on its use in the diagnosis of diseases of the parotid. A. Magnoni says that he uses 40 per cent. lodopin for the purpose. As a contrast medium for salivary ducts this has the advantage over Lipiodol that it is much less viscid. He describes his particular technique in detail and illustrates his paper with sialograms from cases of epidemic parotitis, suppurative parotitis, parotid tumours, parotid lymphadenitis, chronic parotitis, and parotid calculus. In conditions such as a mixed parotid tumour or a parotid lymphadenitis, sialography is seldom of more than academic interest. Unfortunately Magnoni has not always been able to correlate the radiographic findings with accurate bacteriological and cytological information about the saliva, and this leaves some of the interpretations open to doubt.