the services

2
1283 year and the dental work has been extended by the appointment of a second part-time dentist. Out of 3213 children referred for dental treatment 2481 were dealt with. The number of elementary school children examined under the code groups was 4134, and of these 38 per cent. required treatment. Special examinations and inspections amounted to over 9000. Eleven selected cases of discharging ears were treated by zinc ionisation. Four were cured after from 4 to 11 administrations, three ceased attendance, and seven were carried into the new year. The orthopaedic scheme with the remedial exercises clinic is working well. 332 cases were treated during the year and 4442 attendances were made. Mouth-breathers accounted for 129 of these, and infantile paralysis for 52. Shrewsbury. Shrewsbury has an average school attendance of 3715, and of these 1248 were medically examined ; 3-8 per cent. required treatment, and altogether 1148 children made 6371 attendances at the school clinic. Ringworm of the scalp accounted for 183, ringworm of the body for 152, impetigo for 523, and 679 attended for verminous conditions ; 4755 attendances are classed as " miscellaneous." Dental treatment was given to 158 children. An effort is being made to educate the children in elementary hygiene, and the result of this ought shortly to make itself evident in the schools. Dr. H. E. Smith deplores the verminous condition of the children, and the prevalence of impetigo which accompanies personal uncleanliness. He attributes the state of things largely to laziness on the part of both parents and children. The teacher can do a great deal in this direction, and the introduction of lessons on personal hygiene if made practical enough ought to stimulate a consciousness of uncleanliness in the children. But precept without practice is worthless. Bedford. The work of " following up " has been extended in this county by arrangement with the Bedfordshire cursing Association for the district nurse to be present at medical inspection, and later on to visit the homes for the purpose of ascertaining whether treatment has been obtained, and if not, to advise and assist parents in obtaining it. A fee of 7s. 6d. and a capitation grant of 6d. per child medically examined is paid for the nurse’s attendance. The teachers in this way have the help and cooperation of the district nurse, and although dealing with verminous conditions may cause difficulty at first, the utilisation of the district nurse in this connexion ought to be a distinct advan- tage to the county. More attention has been paid to paving, draining, and re-tarring playgrounds this year, and the water-carriage system has been introduced into two schools. The number of children examined in the routine group was 5483, and 69-3 per cent. of the parents were present. Dr. R. T. Herdman emphasises the importance of dry shoes and stockings for children coming from a distance. He says that parents, not teachers, make a difficulty of this matter, and steps are being taken to educate parents. Hartlepool. After the resignation of Dr. G. A. Jubb in April of last year, the post of school medical officer was vacant until Dr. W. McKendrick took over the work after the summer holidays, with the result that much leeway had to be overtaken, as no routine inspections were undertaken until September. Owing to unemploy- ment, many children were compelled to go poorly clad and bootless to school, and funds were raised to provide boots and stockings for these children. There were 14 cases of malnutrition found, none of which required actual treatment. Parents attend the examinations well, and the school clinic is well patronised. Dental treatment is going ahead, and a clinic is shortly to be opened in Hartlepool, so that the long journey to West Hartlepool, hitherto necessary, will be avoided. Gillingham. Dr. NN’. A. Muir, senior medical officer, states that since the last report a considerable improvement has been effected in the general cleanliness of school sanitary arrangements. Sanitary inspectors now inspect at frequent intervals. Much still remains to be done ; in one school there is one hand-basin to 200 boys, and Gillingham is by no means alone in such a penury. Now that so much has been accomplished in remedial provision, it is time to concentrate on preventive measures. Cleanliness is the most impor- tant of these-cleanliness of schools and scholars-and here, as Dr. Muir states, example is better than precept. " A few practical examples of sound hygiene are infinitely more valuable than innumerable lessons on health." In Gillingham if only one nit is found on the hair the child is classified as verminous, with the result that of the 15,763 children examined at the nurses’ inspections, 9-6 per cent. were found verminous. Sacker combs can be hired by the parents at a charge of 1d. The Danish method of treatment for scabies was adopted during the latter half of the year, and in most cases resulted in a cure after a single application. Among 2086 children medically examined, only four cases of rickets were found. At Bournemouth the school medical officer, Dr. W. V. T. Styles, impresses upon parents the advan- tages they have in living near the sea. They are advised gradually to tan the bodies of their children by exposing them by stages to the sun’s rays on the beach in the summer months. Systematic treatment for pre-tuberculous children by sun-baths is carried out daily with excellent results. INFECTIOUS DISEASES IN ENGLAND AND WALES DURING THE WEEK ENDED JUNE 7TH, 1924. Notifications.-The following cases of infectious diseases were notified during the week-namely, small-pox, 69 ; scarlet fever, 1344 ; diphtheria, 657 (as against 788 of the previous week) ; enteric fever, 82 ; pneumonia, 742 (as against 900 of the previous week) ; puerperal fever, 43 ; cerebro-spinal fever, 3 (as against 14 of the previous week) ; acute poliomyelitis, 3 ; acute polio-encephalitis, 1 ; encepha- litis lethargica, 179 (as against 251 of the previous week) ; continued fever, 1 ; dysentery, 10 ; ophthalmia neonatorum, 139. There were no cases of cholera, plague, typhus fever, or trench fever notified during the week. Of the 69 cases of small-pox, 27 were notified from the county of Derby (Derby 10, Chesterfield 11), and 13 from Northumberland (Ashington). Of the cases of encephalitis lethargica, 22 were notified from the County of London, 11 from the county of Durham, 4 from Bristol, 26 from the county of Lancaster (Liverpool 10), Northumberland 11 (Newcastle- upon-Tyne 6, Wallsend 4), Yorks, East Riding, 9 (Hull 8), Yorks, West Riding, 22 (Sheffield 10, Halifax 2, Bradford 2 Wakefield 2, Wetherby 2), and Monmouth 3. Deaths.-In the aggregate of great towns the deaths from influenza fell further from 52 to 46. There were in London 8 deaths from diphtheria, 6 only from measles. The Services. ROYAL NAVAL MEDICAL SERVICE. Surg. Cmdr. J. Thornhill is placed on Retd. List, with the rank of Surg. Capt. - ROYAL ARMY MEDICAL CORPS. Temp. Maj. S. L. Hinde relinquishes his commission and retains the rank of liaj. ARMY RESERVE OF OFFICERS. Lt.-Col. F. E. Gunter, having attained the age limit of liability to recall, ceases to belong to the Res. of Off. Capt. H. A. Harbison ceases to belong to the Res. of Off. on account of physical unfitness. ROYAL AIR FORCE. The undermentioned are granted short service commissions as Flying Officers : A. Dickson and A. A. Townsend. RESERVE OF AIR FORCE OFFICERS. Flying Officer on probation A. Dickson resigns his commission. - INDIAN MEDICAL SERVICE. Col. R. Heard, K.H.S., to be Maj.-Gen. Lt.-Col. E. F. E. Baines to be Col.

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Page 1: The Services

1283

year and the dental work has been extended by theappointment of a second part-time dentist. Out of3213 children referred for dental treatment 2481 weredealt with. The number of elementary school childrenexamined under the code groups was 4134, and ofthese 38 per cent. required treatment. Specialexaminations and inspections amounted to over 9000.Eleven selected cases of discharging ears were treatedby zinc ionisation. Four were cured after from4 to 11 administrations, three ceased attendance, andseven were carried into the new year. The orthopaedicscheme with the remedial exercises clinic is workingwell. 332 cases were treated during the year and 4442attendances were made. Mouth-breathers accountedfor 129 of these, and infantile paralysis for 52.

Shrewsbury.Shrewsbury has an average school attendance of

3715, and of these 1248 were medically examined ;3-8 per cent. required treatment, and altogether 1148children made 6371 attendances at the school clinic.Ringworm of the scalp accounted for 183, ringworm ofthe body for 152, impetigo for 523, and 679 attendedfor verminous conditions ; 4755 attendances are

classed as " miscellaneous." Dental treatment wasgiven to 158 children. An effort is being made toeducate the children in elementary hygiene, and theresult of this ought shortly to make itself evident in theschools. Dr. H. E. Smith deplores the verminouscondition of the children, and the prevalence of

impetigo which accompanies personal uncleanliness.He attributes the state of things largely to laziness onthe part of both parents and children. The teacher cando a great deal in this direction, and the introductionof lessons on personal hygiene if made practical enoughought to stimulate a consciousness of uncleanliness inthe children. But precept without practice is worthless.

Bedford.The work of " following up " has been extended in

this county by arrangement with the Bedfordshirecursing Association for the district nurse to be presentat medical inspection, and later on to visit the homesfor the purpose of ascertaining whether treatment hasbeen obtained, and if not, to advise and assist parentsin obtaining it. A fee of 7s. 6d. and a capitationgrant of 6d. per child medically examined is paid forthe nurse’s attendance. The teachers in this way havethe help and cooperation of the district nurse, andalthough dealing with verminous conditions maycause difficulty at first, the utilisation of the districtnurse in this connexion ought to be a distinct advan-tage to the county. More attention has been paid topaving, draining, and re-tarring playgrounds thisyear, and the water-carriage system has beenintroduced into two schools. The number of childrenexamined in the routine group was 5483, and 69-3per cent. of the parents were present. Dr. R. T.Herdman emphasises the importance of dry shoes andstockings for children coming from a distance. He saysthat parents, not teachers, make a difficulty of thismatter, and steps are being taken to educate parents.

Hartlepool.After the resignation of Dr. G. A. Jubb in April of

last year, the post of school medical officer was vacantuntil Dr. W. McKendrick took over the work after thesummer holidays, with the result that much leewayhad to be overtaken, as no routine inspections wereundertaken until September. Owing to unemploy-ment, many children were compelled to go poorly cladand bootless to school, and funds were raised toprovide boots and stockings for these children.There were 14 cases of malnutrition found, none ofwhich required actual treatment. Parents attend theexaminations well, and the school clinic is wellpatronised. Dental treatment is going ahead, and aclinic is shortly to be opened in Hartlepool, so that thelong journey to West Hartlepool, hitherto necessary,will be avoided.

Gillingham.Dr. NN’. A. Muir, senior medical officer, states that

since the last report a considerable improvement has

been effected in the general cleanliness of schoolsanitary arrangements. Sanitary inspectors now

inspect at frequent intervals. Much still remains to bedone ; in one school there is one hand-basin to 200boys, and Gillingham is by no means alone in such apenury. Now that so much has been accomplished inremedial provision, it is time to concentrate on

preventive measures. Cleanliness is the most impor-tant of these-cleanliness of schools and scholars-andhere, as Dr. Muir states, example is better thanprecept. " A few practical examples of soundhygiene are infinitely more valuable than innumerablelessons on health." In Gillingham if only one nit isfound on the hair the child is classified as verminous,with the result that of the 15,763 children examinedat the nurses’ inspections, 9-6 per cent. were foundverminous. Sacker combs can be hired by the parentsat a charge of 1d. The Danish method of treatmentfor scabies was adopted during the latter half of theyear, and in most cases resulted in a cure after a singleapplication. Among 2086 children medically examined,only four cases of rickets were found.At Bournemouth the school medical officer, Dr.

W. V. T. Styles, impresses upon parents the advan-tages they have in living near the sea. They areadvised gradually to tan the bodies of their childrenby exposing them by stages to the sun’s rayson the beach in the summer months. Systematictreatment for pre-tuberculous children by sun-bathsis carried out daily with excellent results.

INFECTIOUS DISEASES IN ENGLAND AND WALESDURING THE WEEK ENDED JUNE 7TH, 1924.

Notifications.-The following cases of infectious diseaseswere notified during the week-namely, small-pox, 69 ;scarlet fever, 1344 ; diphtheria, 657 (as against 788 of theprevious week) ; enteric fever, 82 ; pneumonia, 742 (asagainst 900 of the previous week) ; puerperal fever, 43 ;cerebro-spinal fever, 3 (as against 14 of the previous week) ;acute poliomyelitis, 3 ; acute polio-encephalitis, 1 ; encepha-litis lethargica, 179 (as against 251 of the previous week) ;continued fever, 1 ; dysentery, 10 ; ophthalmia neonatorum,139. There were no cases of cholera, plague, typhus fever,or trench fever notified during the week. Of the 69 cases ofsmall-pox, 27 were notified from the county of Derby(Derby 10, Chesterfield 11), and 13 from Northumberland(Ashington). Of the cases of encephalitis lethargica, 22were notified from the County of London, 11 from thecounty of Durham, 4 from Bristol, 26 from the county ofLancaster (Liverpool 10), Northumberland 11 (Newcastle-upon-Tyne 6, Wallsend 4), Yorks, East Riding, 9 (Hull 8),Yorks, West Riding, 22 (Sheffield 10, Halifax 2, Bradford 2Wakefield 2, Wetherby 2), and Monmouth 3.Deaths.-In the aggregate of great towns the deaths from

influenza fell further from 52 to 46. There were in London8 deaths from diphtheria, 6 only from measles.

The Services.ROYAL NAVAL MEDICAL SERVICE.

Surg. Cmdr. J. Thornhill is placed on Retd. List, with therank of Surg. Capt. -

ROYAL ARMY MEDICAL CORPS.

Temp. Maj. S. L. Hinde relinquishes his commission andretains the rank of liaj.

ARMY RESERVE OF OFFICERS.

Lt.-Col. F. E. Gunter, having attained the age limit ofliability to recall, ceases to belong to the Res. of Off.

Capt. H. A. Harbison ceases to belong to the Res. of Off.on account of physical unfitness.

ROYAL AIR FORCE.The undermentioned are granted short service commissions

as Flying Officers : A. Dickson and A. A. Townsend.RESERVE OF AIR FORCE OFFICERS.

Flying Officer on probation A. Dickson resigns hiscommission.

-

INDIAN MEDICAL SERVICE.Col. R. Heard, K.H.S., to be Maj.-Gen.Lt.-Col. E. F. E. Baines to be Col.

Page 2: The Services

1284

HONORARY PHYSICIANS AND HONORARY SURGEONSTO THE KING.

To be Honorary Physicians : Col. H. J. K. ]3ainfield,1.M.S., vice Maj.-Gen. SirCourtenayC. Manifold, I.M. S. retd. ;Col. J. H. McDonald, I.M.S., vice Maj.-Gen. C. H. Bowle-Evans, I.M.S. retd. ; Lt. Col. A. Hooton, I.M.S., vice Maj.-Gen. W. E. Jennings, I.M.S.retd.To be Honorary Surgeons : Col. F. Wall, I.M.S., vice

Col. W. G. Pridmore, I.M.S. retd. ; Col. P. Dee, I.M.S., viceCol. H. A. Smith, I.M.S. retd. ; Maj.-Gen. T. H. Symons,I.M.S., vice Maj.-Gen. Sir Gerald G. Giffard, I.M.S. retd.

DEATHS IN THE SERVICES.

Major Valentine Good Johnson, R.A.M.C., who died at’Sidmouth on June 14th, qualified from St. Mary’s Hospitalwith the Conjoint Diploma in 1905, and had been clinicalassistant at the London Lock Hospital and house physicianat the Bethlem Royal Hospital. He joined the Army asLieutenant R.A.M.C. in 1906, reached the rank of Captain in1909, and that of Major in 1918. He was only 45 years of,age, and leaves a wife and many friends to mourn their loss.

Special Articles.VENEREAL DISEASE IN BELGIUM.

A Successful Campaign.A PAPER by Dr. L. Bernard,! of Brussels, on the

-work of his dispensary shows that gonorrhoea is onthe wane, and syphilis is rapidly disappearing as theresult of the concerted measures recently takenagainst them. It is strange to read of a chancre asa rarity, as a lesion which teachers show to studentswith the words : " Mark it well, for you may neversee it again." During the five years the first Statedispensary has existed in Brussels, records have been-compiled of 3319 cases representing 57,674 attend-ances. Of these 3319 cases, 1126 were due to syphilis,1348 to gonorrhoea, 15 to chancroid, and 1 to inguinallympho-granuloma. The remaining 829 personsattended the dispensary because they wronglyfeared they were suffering from venereal disease.Gonorrhoea being much more prevalent than syphilis,it is remarkable that the numbers of these twodiseases treated at the dispensary were approximatelyequal. Evidently many cases of gonorrhoea nevercome to a dispensary for skilled treatment, and thisis one reason why the incidence of gonorrhoea isnot declining as rapidly as that of syphilis. Another.curious difference between syphilis and gonorrhoeawas the relative numbers of the two sexes : apartfrom the cases in children, there were 729 maleand 376 female cases of syphilis, and 996 male andonly 348 female cases of gonorrhoea. These figuressuggest that gonorrhoea in the female is comparativelyoften overlooked.

The Importance of Specialist Diagnosis and Treatment.Dr. Bernard publishes statistics, culled from

official notifications, showing the numerical differencesin the diagnoses of syphilis and chancroid in fullyequipped dispensaries managed by specialists on

.the one hand, and under the conditions of a privateconsultation on the other. In 1921 the ratio ofchancroid to syphilis was 0-74 per cent. at the.dispensaries and 5-15 per cent. at private consulta-tions. As the same great differences were observedin 1920 and 1919, they were evidently not accidental,and it is probable that, for want of sufficient knowledgeand laboratory equipment, physicians are apt tomistake many cases of syphilis for chancroid. Itmay not matter much to the community if a caseof chancroid is taken for one of syphilis, but theopposite mistake may have serious consequences.for both the patient and the community.

The Disappearing Chancre.In 1920 there were as many as 108 cases of primary

<chancre seen at the dispensary. In 1921 this figure1 Bruxelles-M&eacute;dical, 1924, iv., 448.

had fallen to 38, and in 1922 to 12. In 1923 therewere 16 such cases. In the same period there was acorresponding fall in the number of cases of secondarysyphilis, from 102 in 1920 to 11 in 1923. But thenumber of cases of syphilis, showing no apparentlesion, rose from 74 in 1920 to 147 in 1923. Thisdecline of the proportion of primary cases to all thecases of syphilis from 35-64 per cent. in 1920 to8-42 per cent. in 1923 is an amazing achievement.Dr. Bernard publishes a, chart showing the connexionbetween various administrative Acts and the incidenceof syphilis and gonorrhoea. Thus, in the secondquarter of 1920, the Belgian Government providedevery doctor in the country with a free supply ofspecific arsenical preparations, and already in the samequarter the chart shows an abrupt fall in the numberof cases of primary syphilis. The same chart bringsout the interesting fact that propaganda movementstend to coincide with a great increase in the number ofpersons coming to the dispensaries for examination,although they are not suffering from venereal disease.

Sources of Infection in ]}I ale Cases of T’enereal Disease.Dr. Bernard’s classification of the sources of infection

shows some surprising observations. Not a singlecase could be traced to the " official " prostituteswho number about 300 in Brussels, but over 56 percent. of all the new cases could be traced to clandestineprostitutes. Another 24 per cent. could be tracedto " femmes de passage "--a somewhat ill-definedclass which played an important part in the dissem-ination of venereal disease after the armistice whenthe home-coming, demobilised soldier was receivedwith more warmth than discretion by his patrioticcountrywomen. Only about 16 per cent. of the newinfections could be traced to mistresses, and onlybetween 2 and 3 per cent. to wives.

Importance of Examining the Cerebro-spinal Fluidin Syphilis.

The following statistics show how unsafe it is torely solely on a negative serological examination indeciding whether or not syphilis has been cured. In1923 there were 109 cases of syphilis in which theBordet-Gengou reaction was negative in the bloodand there had been no clinical signs of activity forsix months to two years. But only in 30 of thesecases was the reaction negative in the cerebro-spinalfluid-in other words, the cerebro-spinal fluid showedsigns of persistent disease in more than 71 per cent.of the 109 sero-negative cases. In view of thesefindings Dr. Bernard insists that a syphilitic patientwho contemplates matrimony or departure to theBelgian colonies should have his cerebro-spinal fluidas well as his blood tested for syphilis beforeconclusions are drawn as to his fitness for either step.

Arsenical or Bismuth Compounds in Syphilis.In 805 cases arsenobenzene and in 248 cases

bismuth preparations were given. Signs of arsenicalpoisoning occurred in as great a proportion as 18 percent., but no fatalities had to be recorded, althoughin nine cases the sequels, such as exfoliative erythro-dermia, were serious. On one occasion a supply ofarsenobenzene appeared to be particularly toxic, andbhis consignment was therefore withdrawn by themanufacturers. The number of cases of arsenicalpoisoning was greatest during 1919, 1920, and 1921,Mid it would seem that the improvement observedn this respect during 1922 and 1923 must be traced30 the conditions under which arsenobenzene ismanufactured. The monopoly enjoyed by twomanufacturing firms no longer exists, but the manynanufacturers now turning out arsenobenzene anddmilar antisyphilitic preparations have since 19223een under Government control. Dr. Bernard’sexperience with bismuth is most promising. Amongtis 248 cases treated with bismuth there were only19 in which stomatitis developed. No case oflephritis was observed, and there were only twoioubtful cases of jaundice. Bismuth would seem to)e more effective than the arsenic preparations in