Page images
PDF
EPUB

This diffuses rapidly in all directions, not so exclusively upwards as the Report insinuates, for it is heavier than atmospheric air. In the case of the carbon sulphide again, its vapour is so dense that it sinks to the floor, and so marked is this circumstance that certain French doctors have recommended perforation of the shop floor to allow its exit downward.

A suggestion is to be found in the Report that consumption and chest diseases are sometimes direct consequences of naphtha inhalation. I do not see a tittle of evidence in its support. The few statistics printed are too few and valueless for the purpose, and à priori considerations tell against it, inasmuch as naphtha belongs to the same chemical series as turpentine, creosote, and other hydrocarbons which are believed to be of service in the treatment of phthisis and lung diseases. In fact among the many workers in naphtha vapour there is a remarkable absence of cough when at work, and if phthisis does occur, no proof is forthcoming that it does so in a relatively higher ratio than with other operatives.

In my opinion, too, we are still without adequate proof that naphtha, with ordinary care, perceptibly produces disease and shortens life. Still, like as in almost every occupation followed by human beings, that of the rubber manufacturer has some drawbacks to the full enjoyment of life and robustness of health. Those great ends are to be attained only at the sacrifice of almost all the conditions of so-called civilized life. What we are to aim at is to avoid such sacrifice and to secure healthy and happy lives by means of every sanitary expedient practicable.

"A State Medical Service; what should it include?" by
HERBERT MANLEY, M.B., D.P.H.

(FELLOW.) ABSTRACT.

THE idea of a state medical service was mooted so long ago as 1856 by Dr. Rumsey in his very interesting essays on State Medicine. It is proposed in this brief paper to bring this up to date with the present service of Medical Officers of Health as a

basis.

The various districts assigned to Medical Officers of Health are then classified according to work done and emolument with a view to the abolition or material improvement of the less efficient and worst paid inembers of the sanitary service.

The writer then proceeded to enumerate in detail the appointments which may advantageously be combined with that of Medical Officer of Health, to provide a sufficient salary to avoid the necessity of private practice. These are as follows:1. Superintendent of infectious hospital.

2. Vaccination Superintendent.

3. Superintendent Registrar of Births and Deaths.

4. Coroner's Assessor or Medical Expert.

5. Medical Officer of Schools and School Boards.

6. Certifying Factory Surgeon.

7. Analyst?

8. Police Surgeon?

The future position of such an officer is then dealt with, having especial reference to the necessity for fixity of tenure and other conditions of State service.

"Notes on Sanitation in Denmark," by J. CARLSEN, M.D., Medical Statistical Secretary of the Danish Royal Board of Health.

1. Death-rate per cent. for the whole country:—

1890, 18.9; 1891, 19.8; 1892, 19-3; 1893, 190; 1894, 17·6. Death-rate per cent. for population in the towns:1890, 200; 1891, 210; 1892, 20-0; 1893, 19-4; 1894, 18·0. Death-rate for per cent. Copenhagen (330,000 inhabitants):1890, 214; 1891, 21-7; 1892, 19-4; 1893, 20.3; 1894, 19.3. Death-rate per cent. for Larhus (36,000 inhabitants):1890, 210; 1891, 190; 1892, 17·0; 1893, 20.0; 1894, 17.0. 2. Death-rate for 100,000 living persons in towns, 1890-93, from-Small-pox, 0·4; Cholera, 0·0; Diphtheria, 104; Croup, 41; Erysipelas, 9; Scarlatina, 19; Typhus fever (T. exanthematicus), 01; Enteric fever (Febris typhoidea), 15; Relapsing fever, 00; Puerperal fever, 8; Diarrhea (Cholorine et Catarrh intest. acut.), 118; Dysenteria, 03; Whooping cough, 43; Measles, 27; Influenza, 69; Febris rheumatica, 5; Tuberculosis,

283.

For the country population no death-rate can be given, but

as the city population (770,000 persons) for a great part is distributed over the whole kingdom in a great many small towns (the metropolis has 330,000 inhabitants; its suburb, Fredriksberg, 50,000; 400,000 are living in seventy-four towns, the most of a rural character), it may be supposed that the above given death-rates from infectious diseases in the town population do not differ to a great extent from the death-rates for the whole kingdom (2,200,000 inhabitants).

3. Prevailing methods of excreta disposal.

Metropolis. Sewers receiving both rain and waste water, but not sewage from water-closets. The sewage has its outlet in the harbour, frequently flowed through by a strong current. No water-closets, but an obligatory tub system; the contents deposited outside the town. The removal of refuse from houses and streets is carried out by public contract; the house refuse is collected in the yards in transportable reservoirs of galvanized iron with a cover. The refuse is removed to depôts in the environs of the city.

Provincial towns. Thirty-four towns have drainage in almost every street. The rest of the seventy-four towns have open gutters. A single town has water-closets; twenty towns have complete tub system; twenty have partly tubs, partly privypits; the remaining have privy-pits. Removal of house and street refuse and of night-soil is organized by the authorities only in twenty towns. In a single town the application of pulverised peat for all tubs is compulsory.

4. Water supply.

The metropolis has water-works-principally spring water -well filtered. Of seventy-four provincial towns thirty have water-works (the greatest part subterranean water or spring water, a few river water); the remaining forty-four towns have wells as a rule every house has a well. Many wells have bad water. By the sanitary by-laws in most provincial towns the Board of Health is authorised to have the well water examined, to prohibit the use of the well, and in case of necessity to have it filled up.

Some villages have central water supply from springs, the most are using well water.

5. Measures adopted for ascertaining the prevalence of infectious diseases.

For cases of Asiatic cholera, yellow fever, dysentery, exanthematous typhus, small-por and pest, immediate notification is compulsory upon every medical man, and upon everybody who knows or suspects that a case of sickness, occurring in his household, may belong to this class of diseases.

When diphtheria, scarlet fever, measles, typhoid (enteric)

fever, or other diseases are under so-called public management the same compulsory immediate notification is required.

It is the duty of every practising medical man to give to the Medical Officers weekly returns, comprising the observed cases of the above named diseases, besides other diseases, as meningitis, cerebro spin. ep., croup, tussis convulsiva, angina parotidea, febr. intermittens, febris puerperalis, erysipelas. febr. rheumatica, pneumonia crouposa, tracheo-bronchitis, broncho-pneumonia and bronchit. capillaris, angina tonsillaris, cholerine and catarrh, intest. acut., venereal diseases, scabies, and delirium tremens. The monthly figures from these returns are published every month by the Royal Board of Health in a medical paper. The Medical Officer of the Metropolis gives a weekly survey.

6. Measures adopted for isolation of infectious diseases.

7. Hospital accommodation for infectious diseases, whether provided, and if so, whether by the State or by private subscription. When a disease is under public management (the above named serious diseases, Asiatic cholera, etc., are always under "public management"; the other infectious diseases when appearing in a malignant form may be subject to "public management" by a decree from the Minister of Justice) the Board of Health has to provide isolated localities (public buildings, tents, huts or the like), and in case of urgency may take over private property for the purpose. The Board of Health has power to demand that a person attacked, or suspected to be attacked, be removed to those localities, when he cannot be sufficiently isolated in his home.

In almost every town, and in the greatest part of the country districts, every person afflicted with diphtheria, scarlet fever, typhus (enteric) fever, and meningitis cerebrospina epid., has a right to claim free admittance to the hospital for infectious diseases, provided the claim is raised immediately on the outbreak of the disease, or when the nature of the disease is recognised. Persons afflicted with venereal diseases can everywhere require free admittance to a public hospital. The kingdom has many hospitals for infectious diseases: in the metropolis two (e. 500 beds), in the provinces thirty (e. 600 beds); moreover, special departments for infectious diseases. are attached to many provincial hospitals. The total number of beds, intended for patients with these diseases, in the whole

* Vide "Denmark: Its Medical Organization, Hygiene, and Demography.” Presented to the 7th Internat. Congr. of Hyg., London, 1891, Copenhagen. 1891, p. 326.

VOL. XVII. PART IV.

HH

kingdom may be estimated at 1,500. The voluntary use of these beds on the part of the population is considerable and increasing. In the year 1894 11-12,000 cases of diphtheria (including croup), i.e., 60 per cent. of all cases treated by the medical men in the kingdom; and 1,700 cases of enteric fever, i.e., 60 per cent. of all cases treated by the medical men in the kingdom, were isolated in the hospitals, or hospital departments for infectious diseases. All these hospitals are built at the public expense (from the Treasuries of the Commúnes); the annual expenses are defrayed partly from the Treasury of the State, partly from the Treasury of the Communes. 8. Methods of disinfection.

Disinfecting apparatus is attached to all hospitals for infectious diseases, and several other hospitals (some have stoves for dry heat, the most have stoves for steam) as a rule standing at the service of the general public. When diseases are under "public management" disinfection of the infected localities is compulsory. Without "public management" the medical men have a right to claim disinfection at the public expense for cases of diphtheria, scarlet fever, enteric fever, and meningitis cerebro spinalis epid. In many Communes some persons are permanently appointed as "disinfecteurs."

"Argentine Republic and its capital, Buenos Aires," by MANUEL J. PELEGRIN, Consul for the Argentine Republic for Newcastle-upon-Tyne and District.

AREA OF THE REPUBLIC, ITS CLIMATE, IMMIGRATION,
DISEASES, HOSPITALS, &c.

THE Argentine Republic has an area of about 1,212,000 square miles (ten times the size of Great Britain and Ireland) on the eastern side of South America, with a very extensive seaboard on the Atlantic. Speaking generally, the climate is temperate and healthy.

The number of immigrants who landed in the Republic in

« EelmineJätka »