public health in scotland

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aJso advise on measures to prevent spread of infection,but this does not mean she will take over the duties ofthe sanitary inspector.

It will also be the duty of the local health authorityto provide a home nursing service ; and there are greatgaps to be filled here. Many large well-organised districtnursing associations adjoin small and impoverished ones,and some areas have none. At the start most local healthauthorities will need to make full use of existing services,providing financial support, extra equipment, and trans-port where these are needed. The services must bebuilt up so that the family doctor can count on gettingthe aid of the district nurse with as little delay aspossible. A strong case can be made, Dr. Bankssuggests, for placing health visiting, home nursing, anddistrict midwifery all under one superintendent, whowill keep in close touch with general practitioners in herarea and see that their needs are met.When arranging aftercare for patients discharged from

hospital, local health authorities will see that the homeconditions are suitable for their reception, and that theirfamilies are given advice on their care and comfort.The provision of home helps is not going to be easy, butDr. Banks believes it can be achieved. The chief needis a competent enthusiastic organiser who will get toknow the homes in her area and will herself recruit andsupervise the home helps.Ambulance services are an important item : no excuse

can be made for failure to provide an ambulance for acase of accident or sudden illness. Local health authori-ties will work out arrangements most suited to theirareas, some using existing voluntary organisations,others combining the various hospital ambulance servicesof the big cities and making them available for sur-rounding areas, others coordinating their organisationwith the fire-brigade services. This service, perhapsabove all others under the Act, must be efficient.Finally the development of health centres must be

planned, different kinds of centre being tried before anyuniform type is considered.

Public Health in ScotlandThe report of the Department of Health for Scotland 1

for the eighteen months between July, 1945, andDecember, 1946, reveals that, of the 552 men whoentered the medical schools in October, 1946, 302 haddischarged their liability to national service ; while of162 women entrants, 37 had seen service. Shortage ofnurses is no less acute in Scotland than in England; thoughthe number of nurses on the State register increasedsteadily from 14,228 in 1942 to 17,630 in 1946, anddespite some increase in recruitment, the gap betweendemand and supply is still rapidly widening, for in 1946there were 7000 more hospital beds than in 1938. Aselsewhere, the shortage is greatest in sanatoria andmental hospitals where the nursing staff is about 30 %below requirements.The number of persons entitled to benefit under

National Health Insurance rose from 2,047,000 in 1938to 2,270,000 in 1946 ; the cost per head has almostdoubled and now stands at 21 Is. 3d. The rise in thecapitation fee paid to doctors-from 9s. to 15s.-is thusnot as great as the rise in the cost of other services.The general health of Scotland at the close of the

war was good. In 1945 the death-rate was 13-2 ; whilein 1946 the death-rate was 13,1, the birth-rate 20-3-the highest for 20 years-and the infantile mortality-rate 53.8, which is the lowest on record. The maternalmortality-rate-2-2 and also the lowest ever recorded-hasfallen steadily to less than one-third of what it was in1930. Since 1941 when stillbirth became registrable inScotland, the rate has fallen from 40 to 32 per 1000total births ; and the neonatal mortality-rate has fallenin the same period from 39-9 to 29-9. These two ratesmust always be taken together, for the distinctionbetween stillbirth and live birth is legal, not biological.

Notifiable diseases in the period covered by the reportwere low in incidence and lower still in fatality : notifica-tions of diphtheria fell from 15,069 in 1940 to 4988 in1946 ; measles and whooping-cough are not generallynotifiable in Scotland, but mortality from both diseasesshow the greatest fall of recent years. Appendicitis is1. Report of the Department of Health for Scotland. July, 1945—

December, 1946. H.M. Stationery Office. 3s. 6d.

another disease in which mortality has fallen ; it is notcertain whether this is due to fall in incidence or tofall in fatality-rate ; but there is some evidence thatit is due to the latter through the introduction of

chemotherapy.The incidence of tuberculosis causes some uneasiness.

The mortality-rate, which by 1938 had fallen to 69per 100,000 population, rose steadily to 84 in 1941 ; andthe rates for the four- succeeding years were 82, 83, 82,and 79. On December 31, 1945, the total number ofpeople in Scotland known to be suffering from tubercu-losis was 35,116. Notifications during that year totalled8477: 5846 pulmonary and 945 non-pulmonary over15 years of age, and 721 pulmonary and,965 non-

pulmonary under 15 years of age. Deaths numbered3803 : 2932 pulmonary and 871 non-pulmonary.

Venereal disease, which rose steeply on the outbreakof war, started to decline in 1943. New cases recognisedat the clinics in 1945 just exceeded 10,000, of whichtwo-thirds were in males ; but cases of syphilis wereequally divided between the two sexes. Patients whoattended the clinics and were found not to have venerealdisease numbered nearly 8000, and of the females about50 % were found free ; this suggests that the publicitycampaign is succeeding.The important Water (Scotland) Act, 1946, requires

that every new house must have an inside water-supply.Though Scotland had more houses inhabited at the endthan at the beginning of the war, the position was worsethan that in England. LTp to the end of 1946 sites hadbeen approved for 205,703 permanent and 31,226 tem-porary houses ; but only 5879 permanent and 12,556temporary houses had been completed. ,

Poliomyelitis and PolioencephalitisIn the week ended Oct. 4 there was a further slight

decline in the notifications of poliomyelitis to 402 (from441) and of polioencephalitis to 27 (from 32). As wasto be expected, the decline since the peak figure of 662notifications of poliomyelitis in the week ended Sept. 6has been much slower than the rise had been. It seemsprobable therefore that a relatively high incidence maypersist at any rate throughout the rest of this year. Ifthere is a relatively high winter incidence it will bepossible to compare the epidemiological behaviour of thedisease in summer and in winter. The rise and fall ofthe notifications for the last eight weeks is depicted inthe table below.

In the county of London there were 8 more notifica-tions of poliomyelitis (38 from 30) and 2 less of polio-encephalitis (3 from 5). So far this year the deathsascribed to poliomyelitis and polioencephalitis togetherin London have numbered 36. This compares favourablywith the number of deaths ascribed to whooping-cough(68) and to road traffic accidents (24=7).Perhaps the most noteworthy decline in notifications

of poliomyelitis this week was in the West Riding ofYorkshire, where the figure fell to 18 from 34.

Infectious Disease in England and WalesWEEK ENDED OCT. 4

Notifccations.-Smallpox, 0 ; ; scarlet fever, 1086 ;whooping-cough, 1086 ; diphtheria, 218 ; paratyphoid,16 ; typhoid, .12 ;’ measles (excluding rubella), 1256 ;pneumonia (primary or infltienzal), 330 ; cerebrospinalfever, 46 ; poliomyelitis, 402 ; polioencephalitis, 27 ;encephalitis lethargica, 1 ; dysentery, 97 ; puerperalpyrexia, 134 ; ophthalmia neonatorum, 46. No case

of cholera, plague, or typhus was notified during theweek.

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