health in west africa

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NOTES, COMMENTS, AND ABSTRACTS

HEALTH IN WEST AFRICA.

THE latest vital statistics of non-native officialsin West Africa (comprising Gambia, Sierra Leone,Gold Coast, and Nigeria) show that the averagenumber in the service has risen continuously fromabout 1200 in 1903 to over 4000 in 1930. At thesame time the crude death-rate has fallen from20 to 5-3 per 1000, the lowest point yet reached.The "invaliding "-rate shows a similar fall from65 per 1000 in 1903 to 11 per 1000 in 1930. Of the23 deaths in 1930 very few were due directly to tropicaldiseases, while of the 49 cases of invaliding five areattributed to malaria and one to blackwater fever.The largest group, numbering 11, are classified as

neurasthenia, and the figures suggest that the riskof mental breakdown exceeds the risk of physicaldisablement from diseases peculiar to the tropics,and the environmental problems involved deserveattention. The form of the report has been some-what altered from that of previous years. Thedata are now given separately for male and femaleofficers, and new comparative tables have beenintroduced summarising the rates per 1000 of deathsand invalidings in each of the four territories overa period of 20 years. The difficulty in interpretingthese tables, and in using the information relatingto females, lies in the small numbers of personsinvolved. The improvement that has taken placein each territory and in the area as a whole wouldbe far more clearly seen if standardised death-ratescould be incorporated. The crude rates, however,suggest a vast improvement in the health conditionsof the service during the last quarter of a century.

DIPHTHERIA IN A PARIS HOSPITAL.

IN a recent communication to the Academy of Medicine at Paris, Dr. B. Weill-Halle recorded hisobservations on diphtheria at the H6pital des EnfantsMalades in 1929 and 1930. A total of 1210 cases ofdiphtheria were admitted to the special pavilion atthis hospital during this period, and 131 were fatal-a mortality of 10 8 per cent. Ninety-three deathsoccurred among 1054 cases of faucial diphtheria (8-7per cent. mortality), 31 deaths among the laryngealor laryngo-tracheo-brachial cases (22 per cent.), andthere were 7 deaths among 28 cases of paralysis.The mortality was almost the same in each of thetwo years, being 11 per cent. in 1929 and 10 6 percent. in 1930. Comparing these figures with thosewhich he reported from the same hospital in 1903,when he was Prof. Marfan’s house physician, he showsthat there has been a considerable fall in the incidenceof diphtheria-mainly, he says, as the result ofactive immunisation-though the number of severecases still remains high. This severity he attributesto various causes, such as virulence of the organisms,delay in diagnosis and specific treatment, associationwith seasonal infections and a special constitution,especially latent congenital syphilis. Although thetreatment was the same in the two periods, the presentdose of antitoxin was three to four times the amountused in 1901-02. He therefore concludes thatdiphtheria in 1929-30 was a less fatal disease thanin 1901-02 and that diphtheria antitoxin had by nomeans lost any of its efficacy as some maintained.His present practice is to give an intramuscularinjection of antitoxin on admission to hospital inorder to neutralise the circulating toxin and at the

1 West Africa : Vital Statistics of Non-native Officials. Returnsfor 1930. Published by the Crown Agents for the Colonies,Millbank, London, S.W. Pp. 7. 6d.

2 Bull. de l’Acad. de Méd., 1931, CV., 971.

same time to give a subcutaneous injection which ismore slowly absorbed but continues to exercise itsantitoxic effect during the following days. Inapparently hopeless cases an intravenous injectionis given half an hour after the other two injections.and during the next four or five days small doses ofantitoxin are administered by the subcutaneous andintramuscular routes.

THE LIGHTING OF OFFICES.

WE noted last week (p. 258) some recommendationsof the Council of the Illuminating Engineering Societyon the lighting of schools and libraries. A pamphleton the daylight illumination required in offices ispublished by the Department of Scientific andIndustrial Research.1 It might be thought that theadequacy of the natural lighting at any point in a roomwould depend solely upon the actual illumination atthat point, so that a room which might seem lightenough on a bright day would seem inadequatelylighted on a dull day. Some time ago evidence wasobtained that this is not so, but that, over a widerange of actual illumination values, the adequacy orinadequacy of the lighting at any given point isclosely correlated with the daylight factor at thatpoint. To study this point a "jury" of observers,including architects, illuminating engineers, andothers, visited certain rooms in Whitehall and judgedthe adequacy of the lighting in different parts of theroom. The result of the work was the conclusion thatlighting in an office is adequate when the daylightfactor equals or exceeds 0-2 per cent.-i.e., a sill ratioof 0-4 per cent. This is exactly the figure taken as aminimum of adequate lighting by the committee whosereport was noticed last week.

GREAT MEN IN PUBLIC HEALTH.

YET another book 2 inspired by the names of thegreat sanitarians inscribed on the façade of the newSchool of Hygiene in Gower-street. There is, perhaps,more to be said than appears at first sight for suchinstitutions giving on busy, noisy streets. Dr. Tobeydoes not restrict himself (as did M. E. M. Walkerin his " Pioneers of Public Health" 3) to the 21 selectedheroes. He ranges over the whole history of publichealth, and writes accurately and interestingly of theprogress of sanitary science from Moses to Gorgasand after. He goes to some extent off the track,which has been beaten pretty hard in recent years, andthose who are a little bored with Lister, Pasteur, andFlorence Nightingale can turn for refreshment to thechapters on W. T. Sedgwick, Trudeau, and the mentalhygienists. The book is beautifully produced (exceptfor the binding).

ERRATA.—In a report of a paper read beforethe Section of Pathology of the British MedicalAssociation on July 22nd (p. 247) Dr. G. Roche Lynchis credited with a statement that " the employmentof a non-medical analyst seriously embarrassed thework of highly skilled men." This misrepresents hismeaning; for the point he wished to make was thatfaulty observation by the medical man at the post-mortem seriously embarrasses the work of the non-medical analyst.In an annotation, entitled Sympathetic Ganglion

Lesions in Scleroderma, which appeared on

p. 255 of our last issue, the name of Dr. GeoffreyRake was incorrectly given. Dr. Rake, who wasformerly resident at Guy’s Hospital, is at presentworking at the Rockefeller Institute in New York.

1 Illumination Research Technical Paper, No. 12. H.M.Stationery Office. 1931. Pp. 10. 3d.

2 Riders of the Plagues: the Story of the Conquest ofDisease. By J. A. Tobey, Dr.P.H. New York: Scribner.1930. Pp. 348. 9 plates. 12s. 6d.

See THE LANCET, 1930 ii., 671