Tuberculosis : Compulsory Removal to Hospital
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819 diphtheria. In this age-group the number of deaths from accidents is the same as that for the common infectious diseases and respiratory infections combined : drowning causes as many as 40% (doubtless because of the nature of the country), traffic accidents 30%, and burns 10%, and the accident death-rate is twice as great in the country as in the towns. van Gelderen showed that the most important single factor in the prevention of accidents in the young child is a high standard of maternal care, and he regards system- atic instruction of mothers in accident prevention as very important. Poliomyelitis Notifications of poliomyelitis in England and Wales in the week ended Oct. 1 (39th week) showed little change from the preceding week. The figures were (38th week in parentheses) : paralytic 207 (201), non-paralytic 180 (193), total 387 (394). Regionally the figures decreased in the North Midland, London and South-Eastern (including Greater London), and South-Western regions and in Wales. There were slight increases in the East and West Ridings and in the Northern, North-Western, Midland, Eastern, and Southern regions. In Greater London, Willesden notified a further 11 I cases and Harrow 4. The following figures give the total uncor- rected notifications in the 39th week during the past six years (percentage of paralytic cases in parentheses) : 1950, 332 (66-9%); 1951, 108 (59-2%); 1952, 162 (64’2 %) ; 1953, 157 (503 %) ; 1954, 70 (57-1%); and 387 (53-5%). Although the proportion of non-paralytic cases dropped further to more normal proportions, there were still 12 counties in which non-paralytic cases exceeded or equalled paralytic ones. This excess was particularly striking in Middlesex, Essex, and Surrey. In 1955 so far the proportion of non-paralytic cases has been approximately 46-1% of the total. The corresponding figures in the preceding four years were: 1951, 41-5%; 1952, 29-8%; 1953, 34-6 % ; 1954, z8 %. It is reported from the United States that the polio- myelitis-rate among children aged 5 to 9 who had had vaccine was 25-50 % lower than among those not vaccinated. Preliminary findings are described as " very encouraging." Well-water Cyanosis In this country cyanosis in infancy due to nitrate contamination of well-water is uncommon ; but in 1951 Ewing and Mayon-White reported from Suffolk three cases (one fatal) associated with a high nitrate content of water from shallow, insufficiently lined wells, used to make up artificial feeds. Well-water cyanosis, which is limited to the first few weeks of life, is due to the conversion of nitrates to nitrites by coli- form bacteria in the intestine. The nitrites enter the blood- stream and convert haemoglobin to methaemoglobin, which is too stable for transport of oxygen, and reduces the oxygen- carrying power of the blood. Taylor 2 suggested that 20 parts of nitrates per million should be regarded as the highest acceptable figure in water used for preparing an infant’s milk mixture. Dr. A. C. Gee, in his report for 1954 as medical officer of health for Lothingland, Suffolk, remarks that in that area a case of well-water cyanosis was detected about the same time as those recorded by Ewing and Mayon- White ; and he describes a scheme for ensuring the safety of the water used in artificial feeding. By this scheme, which has now been in operation for some two years, district midwives inform the health department of coming confinements and report on the source of the water-supply. If this is a well, samples are taken for analysis ; and when analysis indicates that the water is likely to be dangerous, an alternative supply is provided if artificial feeding becomes necessary. But, Dr. Gee adds, the scheme is proving difficult to - administer, since not all mothers come under the care of the mid- wives. He suggests that doctors and hospitals serving rural areas should bear in mind the potential dangers of 1. New York Times, Oct. 2, 1955. 2. Ewing, M. C., Mayon-White, R. M. Lancet, 1951, i, 931. 3. Taylor, E. W. The Examination of Water and Water Supplies. London, 1949. well-water and that, where necessary, the local health authority should be asked to analyse the water-supply in the home. Western European Union The Public Health Committee of the Western European Union met in London on Oct. 4-7. The meeting was attended by delegates of the five Brussels Treaty countries (Belgium, France, Luxembourg, the Nether- lands, and the United Kingdom) and of two new member-countries Italy and the Federal German Republic. The committee decided to make a preliminary study of air pollution in the seven countries. It also decided to extend to Italy and the Federal German Republic the arrangements by which no health control is imposed on an aeroplane or ship between member-countries. The next meeting of the committee will be held in Paris next April. Statistics for England and Wales The Registrar-General’s return for the June quarter of this year appeared last week.! The principal births and deaths figures were published in an earlier weekly return.2 Provisional figures of causes of death in the March quarter of 1955 show that measles caused 58 deaths-8 more than for the whole of 1954, which had a record low figure of 50 deaths. The figure for the March quarters of 1954 and 1953 (the last epidemic year) were 15 and 142 respectively. There were only 2 deaths from diphtheria. A sharp rise in the number of deaths from poisoning by domestic gases brought the number of deaths from all forms of accidental poisoning to 459. The figures for the preceding three quarters were 278, 168, and 243. There was also an increase in the total number of deaths from falls, but while those of women numbered 1030 compared with 971 in the March quarter of 1954, those of men numbered 601, compared with 646. Medicine and the Law Tuberculosis : Compulsory Removal to Hospital THE magistrates at Haverfordwest have ordered the removal to hospital of a man suffering from tuberculosis of the respiratory tract. The case was said to be the first of its kind in Pembrokeshire.3 The case concerned a 40-year-old married man with four children. He was a casual labourer and had not worked for some time. In July he was admitted to hospital but discharged himself against medical advice a few weeks later. He returned home and stayed there with his wife ; his children had been removed because of his infectious condition. He had been using public transport and mixed with other people although he was a source of infection. He had refused to return to hospital despite pressure by his own doctor, the district nurse, the county medical officer, the assistant chest physician, and the chest-clinic sister. On the application of the Pembrokeshire County Council under section 172 of the Public Health Act, 1936, the magis- trates ordered his removal to hospital for three months. This is the maximum period of detention allowed by the section, but the county council can apply for a renewal of the order. Section 172 applies only to cases of tuberculosis of the respiratory tract. The application must be made either by the county council or by the local authority, who must show : (a) that the patient’s circumstances are such that proper precautions to prevent the spread of infection cannot be taken, or that such precautions are not being taken ; (b) that serious risk of infection is thereby caused to other persons ; (c) that accommodation is available for the patient in a suitable hospital or institution. 1. The Registrar-General’s quarterly return no. 426. H.M. Stationery Office. Pp. 24. 1s. 6d. 2. See Lancet, July 30, 1955, p. 244. 3. Pembroke County Guardian, Sept. 16, 1955.
Transcript of Tuberculosis : Compulsory Removal to Hospital
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diphtheria. In this age-group the number of deaths fromaccidents is the same as that for the common infectiousdiseases and respiratory infections combined : drowningcauses as many as 40% (doubtless because of the nature ofthe country), traffic accidents 30%, and burns 10%, and theaccident death-rate is twice as great in the country as in thetowns. van Gelderen showed that the most important singlefactor in the prevention of accidents in the young child is ahigh standard of maternal care, and he regards system-atic instruction of mothers in accident prevention as veryimportant.
PoliomyelitisNotifications of poliomyelitis in England and Wales
in the week ended Oct. 1 (39th week) showed little changefrom the preceding week. The figures were (38th weekin parentheses) : paralytic 207 (201), non-paralytic 180(193), total 387 (394). Regionally the figures decreasedin the North Midland, London and South-Eastern(including Greater London), and South-Western regionsand in Wales. There were slight increases in the Eastand West Ridings and in the Northern, North-Western,Midland, Eastern, and Southern regions. In GreaterLondon, Willesden notified a further 11 I cases andHarrow 4. The following figures give the total uncor-rected notifications in the 39th week during the pastsix years (percentage of paralytic cases in parentheses) :1950, 332 (66-9%); 1951, 108 (59-2%); 1952, 162(64’2 %) ; 1953, 157 (503 %) ; 1954, 70 (57-1%); and387 (53-5%). Although the proportion of non-paralyticcases dropped further to more normal proportions, therewere still 12 counties in which non-paralytic cases
exceeded or equalled paralytic ones. This excess wasparticularly striking in Middlesex, Essex, and Surrey.In 1955 so far the proportion of non-paralytic cases
has been approximately 46-1% of the total. The
corresponding figures in the preceding four yearswere: 1951, 41-5%; 1952, 29-8%; 1953, 34-6 % ;1954, z8 %.
It is reported from the United States that the polio-myelitis-rate among children aged 5 to 9 who had hadvaccine was 25-50 % lower than among those notvaccinated. Preliminary findings are described as
" very encouraging."
Well-water CyanosisIn this country cyanosis in infancy due to nitrate
contamination of well-water is uncommon ; but in1951 Ewing and Mayon-White reported from Suffolkthree cases (one fatal) associated with a high nitratecontent of water from shallow, insufficiently linedwells, used to make up artificial feeds.
Well-water cyanosis, which is limited to the first few weeksof life, is due to the conversion of nitrates to nitrites by coli-form bacteria in the intestine. The nitrites enter the blood-stream and convert haemoglobin to methaemoglobin, which istoo stable for transport of oxygen, and reduces the oxygen-carrying power of the blood. Taylor 2 suggested that 20parts of nitrates per million should be regarded as the highestacceptable figure in water used for preparing an infant’smilk mixture.
Dr. A. C. Gee, in his report for 1954 as medical officerof health for Lothingland, Suffolk, remarks that in thatarea a case of well-water cyanosis was detected aboutthe same time as those recorded by Ewing and Mayon-White ; and he describes a scheme for ensuring the
safety of the water used in artificial feeding. By thisscheme, which has now been in operation for some twoyears, district midwives inform the health departmentof coming confinements and report on the source of thewater-supply. If this is a well, samples are taken foranalysis ; and when analysis indicates that the wateris likely to be dangerous, an alternative supply is providedif artificial feeding becomes necessary. But, Dr. Geeadds, the scheme is proving difficult to - administer,since not all mothers come under the care of the mid-wives. He suggests that doctors and hospitals servingrural areas should bear in mind the potential dangers of
1. New York Times, Oct. 2, 1955.2. Ewing, M. C., Mayon-White, R. M. Lancet, 1951, i, 931.3. Taylor, E. W. The Examination of Water and Water Supplies.
London, 1949.
well-water and that, where necessary, the local healthauthority should be asked to analyse the water-supplyin the home.
Western European UnionThe Public Health Committee of the Western European
Union met in London on Oct. 4-7. The meeting wasattended by delegates of the five Brussels Treatycountries (Belgium, France, Luxembourg, the Nether-lands, and the United Kingdom) and of two newmember-countries - Italy and the Federal GermanRepublic.The committee decided to make a preliminary study
of air pollution in the seven countries. It also decidedto extend to Italy and the Federal German Republic thearrangements by which no health control is imposed onan aeroplane or ship between member-countries.The next meeting of the committee will be held in
Paris next April.
Statistics for England and WalesThe Registrar-General’s return for the June quarter of
this year appeared last week.! The principal births anddeaths figures were published in an earlier weeklyreturn.2 Provisional figures of causes of death in theMarch quarter of 1955 show that measles caused 58deaths-8 more than for the whole of 1954, which hada record low figure of 50 deaths. The figure for theMarch quarters of 1954 and 1953 (the last epidemicyear) were 15 and 142 respectively. There were only2 deaths from diphtheria. A sharp rise in the number ofdeaths from poisoning by domestic gases brought thenumber of deaths from all forms of accidental poisoningto 459. The figures for the preceding three quarters were278, 168, and 243. There was also an increase in thetotal number of deaths from falls, but while those ofwomen numbered 1030 compared with 971 in the Marchquarter of 1954, those of men numbered 601, comparedwith 646.
Medicine and the Law
Tuberculosis : Compulsory Removal to HospitalTHE magistrates at Haverfordwest have ordered the
removal to hospital of a man suffering from tuberculosisof the respiratory tract. The case was said to be the firstof its kind in Pembrokeshire.3
The case concerned a 40-year-old married man with fourchildren. He was a casual labourer and had not worked forsome time. In July he was admitted to hospital but dischargedhimself against medical advice a few weeks later. He returnedhome and stayed there with his wife ; his children had beenremoved because of his infectious condition. He had beenusing public transport and mixed with other people althoughhe was a source of infection. He had refused to return to
hospital despite pressure by his own doctor, the districtnurse, the county medical officer, the assistant chest physician,and the chest-clinic sister.
On the application of the Pembrokeshire County Councilunder section 172 of the Public Health Act, 1936, the magis-trates ordered his removal to hospital for three months. Thisis the maximum period of detention allowed by the section,but the county council can apply for a renewal of theorder.
Section 172 applies only to cases of tuberculosis of therespiratory tract. The application must be made eitherby the county council or by the local authority, who mustshow : (a) that the patient’s circumstances are such thatproper precautions to prevent the spread of infectioncannot be taken, or that such precautions are not beingtaken ; (b) that serious risk of infection is thereby causedto other persons ; (c) that accommodation is availablefor the patient in a suitable hospital or institution.
1. The Registrar-General’s quarterly return no. 426. H.M.Stationery Office. Pp. 24. 1s. 6d.
2. See Lancet, July 30, 1955, p. 244.3. Pembroke County Guardian, Sept. 16, 1955.
