I7o

Hertfordshire County Sanatorium, Medical Superintendent: Dr A. P. F O R D

Ware Park

Ware Park Sanatorium as seen from the air.

As is the case with so many other such institutions throughout the country, Ware Park Sanatoruim is situated in a converted pr ivate estate, the mansion being used for a Nurses Home and for administrat ive purposes, the wards being large wooden hutments. The institution is situated amongst beautiful surroundings but the buildings themselves leave much to be desired, a l though a large amount of money has recently been spent to make them as comfortable and up to date as possible. Plans had already been passed for a new sanatorium in 1939, but this very desirable improvement must now, alas, await less difficult times.

I n normal times there are I36 beds available, all types o f adult patients both male and female being admitted. Recently owing to shortage of staff it has been necessary to close a number of beds but the position is improving chiefly because of the arrival of several Latvian women who are working as ward orderlies.

An impor tan t feature of the sanatorium is a modern Four Valve Rotat ing Anode X- ray apparatus together with tomograph, which was installed in November i945. There is no operat ing theatre and consequently arrange- ments have to be made for the patients to be transferred to o ther institutions for the various surgical measures required.

T h e medical sta'Nng of the sanatorium

differs from most others in that the T u b e r c u l o s i s Officers visit the sana tor ium and ca r ry o u t t:he t reatment of their own patients, a n a r r a n g e m e ~ l t considered advantageous bo th f rom the pa t l . en t s ' and the doctors' points of view. T h e G h i e f Tuberculosis Officer acts as p a r t - t i m e n o n - resident Medical Superintendent , the r e s i d e n t s being a Deputy Medlcal Super in tenden t a n d a Resident Medical Officer. The re is a w e e k l y ~round' in which the whole of the m e d i c a l s t a f f see all the patients and review their p r o g r e s s and treatment. There is also a m o n t h l y ses s ion when the visiting Thorac ic Surgeon, M r O . S. Tubbs, attends to discuss with the m e d i c a l s t a f f such patients as are considered su i t ab l e for surgical treatment.

In addition to the sanator ium beds t h e r e is a small colony of some T 2 m e n and 4 to 6 w o m e n who, after their period of s ana to r ium t r e a t m e n t has been completed, r ema in at the i n s t i t u t i o n and are employed in various duties s u c h as poultry keeping, van driving, w a r d m a i d s or porters, etc. Many of these colonists are s u f f e r i n g from advanced and extensive disease a n d i t h a s proved necessary for t h e m to r e tu rn t o t he sanatorium from time to t ime for fu r the r t r e a t - ment. By this method, however, it is pos s ib l e to segregate for the last months or years o f t h e i r lives m a n y patients who would o therwise b e a source of infection.

Augus t I947 T U B E R C L E

Summary of work carried out during 1945 : - Number admitted . . . . 373

,, discharged . . . . 24-7 deaths . 28

O f the' patients who were" discharged:-- Improved . . . . . . 19 i Stationary . . . . . . 44 Worse . . . . . . . . 12

247 Patients' average stay in Sana-

torium .. . i37 days T h e average number of beds

occupied during the year .. 88

Annual N O R T H R I D I N G OF Y O R K S H I R E

C O U N T Y C O U N C I L . Annual Report of the Medical OMcer of Health (J. A. Fraser) for the Year I945. October, i946.

The North Riding of Yorkshire is the third county in order of acreage in England with an estimated population of 314,42o of which the greater part inhabits urban districts. The cotmty varies from a populous area with heavy indus- tries, such as iron mining and steel making, in the neighbourhood of Middlesbrough, to sparsely inhabited dales and moorland districts on the ;vest and seaside resorts, such as Scarborough, on the east. The vital statistics for i945 are not entirely favourable; the general death-rate was i 3"5; the birth-rate was r 7'8; the infant mortality was 55.I (compared with 4 I ' 4 in r944); and maternal mortality was 3'42. All these figures are adverse compared with the records for England and Wales.

Among the principal causes of death tuber- culosis stood fifth, t h u s : ~

H e a r t disease . . . . . . 1,286 Cancer . . . . . . . . 593 Intracranial vascular lesions .. 505 Bronchitis . . . . . . . . 213 T u b erculosis 185 Congenital debility; "malformations

and premature births . . . . 176 Pneumonia . . . . . . . . I56 Circulatory diseases, other than heart

disease . . . . . . . I55 Nephritis . . . . . . . . 128 T h e tuberculosis death-rate stood at o'44 for

pulmonary and o.I 5 for non-pulmonary cases; the former is, and, for some years, has been below the rates for England and Wales, while the latter has kept about on the same level. Interest attaches to the number of deaths and new cases when distributed according to sex, thus: The new pulmonary cases were not far apart , 85 male and 79 female, but the deaths numbered 82 male and only 56 female, while

X-ray films taken during the year . . . . . . . . I,o66

Number of patients on w h o m collapse therapy was com- menced during the year .. 83

Patients sent to hospitals for Surgical Treat - rnent : - -

Thoracoscopy .. Thoraeoplas W .. Phrcnie crush ..

. . . . 62

. . . . 14

. . . . I N

91

Reports for non-pulmonary the new cases were 47 male and 49 female, with 29 male deaths and only I8 female. We have before drawn attention to this greater tendency of males to succumb to the infection of tuberculosis, particularly in middle life. The trend for new cases to increase in number appears to be checked. Acute shortage of nurses and domestic staff at sanatoria caused a waiting list while the available accommodation is, at best, inadequate.

D E R B Y S H I R E C O U N T Y C O U N C I L . Annual Report of the County Medical Officer .of Health (J. B. S. Morgan) for the Year I945. County Offices, Derby. November, i946.

The population of the county of Derby, amount- ing to 626,75o, is nearly equally divided between rural districts and urban districts with municipal boroughs. T h e general death-rate for the year was i ~.o with a birth-rate of I8.2, that of the urban districts being below that of the rural districts, I7. 9 as against i8. 4. The infant mortality was 44'5. Maternal mortality which was 3.65 in I938 had fallen to I "42, a gratifying decline ascribed to improved obstetrical practice with the use of sulphonamides and penicillin, while steps a re being taken to open new county maternity homes. The death-rate per I,ooo from all forms of tuberculosis, o.36, was the lowest on record; it is based on 227 deaths, compared with 315 in i937. Notified new cases also showed a reduction from 6I 2 in I943 to 58~. The county has 9 tuberculosis dispensaries and Io orthopaedic clinics, as well as over 200 beds set aside for tuberculous patients. No mention is made of any waiting list or staff difficulties in the sanatoria. The use of artificial pneumothorax is increasing; it is commenced in the sanatorium and later, refills are continued at the dispensaries with frequent x-ray examinations. The county is reported to possess certain industries, e.g. dressing millstone grit and silica brick ma!dng, known to predispose to silicosis and tuberculosis, bu t no