public health

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410 before Sheriff More, at. Banff on Jan. 25th, when Georgina Isabella Logan was charged with beating a dumb woman patient at Ladybridge Asylum, Banff, with a shoe, when in defence she stated that she had seen other nurses do the same thing ; what steps were being taken to safe- guard these patients against treatment of this kind in future ; and if inquiry would be held into the alleged brutalities in this institution. Mr. ELLIOT replied : Georgina Isabella Logan, aged 18, joined the Banff District Asylum staff as a nurse proba- tioner on Jan. 2nd, 1938. The assault on the patient was committed on Jan. 10th. The matter was reported to the Medical Superintendent next day, and he immediately suspended Nurse Logan and reported the matter to the Procurator-Fiscal. On Jan. 25th Nurse Logan pleaded guilty and the Sheriff deferred sentence till May llth. Nurse Logan has since been dismissed from the asylum service. The asylum authorities have inquired into Nurse Logan’s statement that she had seen other nurses do the same thing. The inquiries were made at the asylum by the county clerk and his deputy, and they reported that they were satisfied that there was no ground for the allegations. Any asylum nurse striking a patient is liable to instant suspension followed by dismissal, and all such offences are reported to the Procurator-Fiscal in order that criminal proceedings may be considered. The General Board of Control have considered this case and are satisfied that it is an isolated one, but I have asked the Board to furnish me with a fuller report on the whole matter. Food and Drugs Consolidation Bill Mr. HALL CAINE asked the Minister of Health what steps he proposed to take to negotiate with the various interests concerned as to the terms of the draft Food and Drugs Consolidation Bill; and whether he would give an undertaking that all the interested bodies would be consulted before the Bill was presented to Parliament.- Mr. BERNAYs replied : The draft Bill has been published and placed on sale, and my right hon. friend will be prepared to consider representations from any interested bodies before the Bill is presented to Parliament. PUBLIC HEALTH Local Outbreaks of Typhoid THE sharp rise in the number of cases of enteric fever in the Weekly Return is accounted for chiefly by 9 cases in Somerset (Bridgwater R.D. 8, Burnham- on-Sea 1) and 26 cases in Pembroke (Haverfordwest R.D. 25, Fishguard 1). The remaining 26 are scattered cases in Chester 2 (Stockport, Altrincham) ; Cornwall 1 (Scilly) ; Derby 2 (Staveley, Chesterfield R.D.) ; Durham 1 (Gateshead) ; Hertford 1 (Bishops Stortford) ; Kent 1 (Orpington) ; Lincoln 1 (Scunthorpe) ; London 8 (Hampstead 2, St. Marylebone 1, Stepney 3, Wandsworth 1, Westminster 1) ; Middlesex 1 (Ruislip) ; Northumberland 1 (Newcastle- on-Tyne) ; Nottingham 1 (Warsop) ; Southampton 1 (New Forest R.D.) ; Surrey 3 (Coulsdon, Sutton, Godstone R.D.) ; Warwick 1 (Rugby) ; Glamorgan 1 (Swansea). In the Highbridge area of Somerset 30 cases have been reported up to the present time with 3 deaths. No direct evidence of the cause of the outbreak has yet been discovered. Dr. J. F. Davidson, county medical officer, is being assisted in his investigations by Dr. Norman Smith of the Ministry of Health. All public water is being chlorinated and instruction given to boil both water and milk, although so far there is no indication that the infection is being spread by either. Sunday schools and infant schools at Highbridge and Huntspill have been closed for the time. Huntspill itself is now taking its water from the Bridgwater town supply which is easier to chlorinate than is the rural supply. Axbridge isola- tion hospital has been reserved for the typhoid cases, other infectious diseases being accommodated for the time elsewhere. At Burnham-on-Sea employees in local industries coming from the Highbridge area have been asked to remain at home and the public has been advised against the eating of lettuce and tomatoes. In North-west Pembroke around St. David’s 29 cases have been notified with 2 deaths. All the patients have been sent to the isolation hospital on the outskirts of Pembroke Dock where a scarlet fever ward has been cleared, and there has been some local apprehension from the concentration of typhoid cases in so populous an area. Here again Dr. H. Middleton, county M.O.H., has stated that all possible precautions have been taken, and special injunction has been issued to those who handle food to wash their hands before doing so. In Northumberland 21 cases in all have recently been reported. The Newcastle health department states that none of the patients is now seriously ill and that so far it has not been found possible to trace the source of the infection. The Comprehensive Health Visitor Since 1929 the tendency has been for local authorities to appoint health visitors, each of whom will carry out all the duties of health visiting and nursing, including school nursing. In a paper pub- lished in the Journal of State Medicine for January, 1938, Miss E. J. Moorehead, superintendent of health visitors at St. Helens, brings forward weighty objec- tions to this policy, but does not perhaps give due value to the three reasons why most medical officers of health favour it. The chief of these is that the divorce of school medicine from child welfare inhibits the continuance of supervision-and supervision of the rearing of children is the main function of the health visitor. Miss Moorehead thinks it an advantage to dissociate preventive from curative nursing. We do not accept this argument, for when preventive work becomes clinical, being applied to individuals, its separation from curative work is artificial. We agree that if health visitors are to do all public health nursing, their district must be limited ; but people do not like unnecessarily many invaders of their homes and we submit that a district is better served by health visitors to each of whom a part of the area is assigned than by the same number serving the whole in different capacities. ABSORPTION OF FAT.-At a meeting of the Society of Public Analysts and Other Analytical Chemists on Feb. 2nd, with Dr. G. Roche Lynch, the president, in the chair, Dr. A. C. Frazer read a paper on fat absorption and metabolism. He presented evidence that passage of fats through the walls of the small intestine can take place without hydrolysis to fatty acids and glycerol. In cats such hydrolysis cannot occur, for there is no lipase in the intestines. In human beings lipase is present and part of the fats ingested penetrates the intestinal walls as fatty acids, but a large proportion penetrates unchanged. The fatty acid portion passes to the fat depots by way of the portal vein, liver, and hepatic vein, but the unhydrolysed fat avoids the liver and passes to the fat depots by way of the lacteal lymphatics and the systemic vessels. The presence of particles of unhydro- lysed fat in the blood was detected microscopically by use of dark-ground illumination, and this means was used to study variations in the concentration of the fat particles in the blood in course of digestion.

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Page 1: PUBLIC HEALTH

410

before Sheriff More, at. Banff on Jan. 25th, when GeorginaIsabella Logan was charged with beating a dumb womanpatient at Ladybridge Asylum, Banff, with a shoe, whenin defence she stated that she had seen other nurses dothe same thing ; what steps were being taken to safe-guard these patients against treatment of this kind infuture ; and if inquiry would be held into the allegedbrutalities in this institution.

Mr. ELLIOT replied : Georgina Isabella Logan, aged 18,joined the Banff District Asylum staff as a nurse proba-tioner on Jan. 2nd, 1938. The assault on the patient wascommitted on Jan. 10th. The matter was reported tothe Medical Superintendent next day, and he immediatelysuspended Nurse Logan and reported the matter to theProcurator-Fiscal. On Jan. 25th Nurse Logan pleadedguilty and the Sheriff deferred sentence till May llth.Nurse Logan has since been dismissed from the asylumservice. The asylum authorities have inquired intoNurse Logan’s statement that she had seen other nursesdo the same thing. The inquiries were made at the

asylum by the county clerk and his deputy, and they

reported that they were satisfied that there was no groundfor the allegations. Any asylum nurse striking a patientis liable to instant suspension followed by dismissal,and all such offences are reported to the Procurator-Fiscalin order that criminal proceedings may be considered.The General Board of Control have considered this case andare satisfied that it is an isolated one, but I have asked theBoard to furnish me with a fuller report on the wholematter.

Food and Drugs Consolidation Bill

Mr. HALL CAINE asked the Minister of Health whatsteps he proposed to take to negotiate with the variousinterests concerned as to the terms of the draft Food and

Drugs Consolidation Bill; and whether he would give anundertaking that all the interested bodies would beconsulted before the Bill was presented to Parliament.-Mr. BERNAYs replied : The draft Bill has been publishedand placed on sale, and my right hon. friend will be

prepared to consider representations from any interestedbodies before the Bill is presented to Parliament.

PUBLIC HEALTH

Local Outbreaks of TyphoidTHE sharp rise in the number of cases of enteric

fever in the Weekly Return is accounted for chieflyby 9 cases in Somerset (Bridgwater R.D. 8, Burnham-on-Sea 1) and 26 cases in Pembroke (HaverfordwestR.D. 25, Fishguard 1).The remaining 26 are scattered cases in Chester 2

(Stockport, Altrincham) ; Cornwall 1 (Scilly) ; Derby 2(Staveley, Chesterfield R.D.) ; Durham 1 (Gateshead) ;Hertford 1 (Bishops Stortford) ; Kent 1 (Orpington) ;Lincoln 1 (Scunthorpe) ; London 8 (Hampstead 2,St. Marylebone 1, Stepney 3, Wandsworth 1, Westminster1) ; Middlesex 1 (Ruislip) ; Northumberland 1 (Newcastle-on-Tyne) ; Nottingham 1 (Warsop) ; Southampton 1

(New Forest R.D.) ; Surrey 3 (Coulsdon, Sutton, GodstoneR.D.) ; Warwick 1 (Rugby) ; Glamorgan 1 (Swansea).

In the Highbridge area of Somerset 30 cases havebeen reported up to the present time with 3 deaths.No direct evidence of the cause of the outbreak has

yet been discovered. Dr. J. F. Davidson, countymedical officer, is being assisted in his investigationsby Dr. Norman Smith of the Ministry of Health. All

public water is being chlorinated and instruction

given to boil both water and milk, although so farthere is no indication that the infection is beingspread by either. Sunday schools and infant schoolsat Highbridge and Huntspill have been closed forthe time. Huntspill itself is now taking its waterfrom the Bridgwater town supply which is easier tochlorinate than is the rural supply. Axbridge isola-tion hospital has been reserved for the typhoid cases,other infectious diseases being accommodated forthe time elsewhere. At Burnham-on-Sea employeesin local industries coming from the Highbridge areahave been asked to remain at home and the publichas been advised against the eating of lettuce andtomatoes.

In North-west Pembroke around St. David’s29 cases have been notified with 2 deaths. Allthe patients have been sent to the isolation hospitalon the outskirts of Pembroke Dock where a scarletfever ward has been cleared, and there has been somelocal apprehension from the concentration of typhoidcases in so populous an area. Here again Dr. H.Middleton, county M.O.H., has stated that all possibleprecautions have been taken, and special injunctionhas been issued to those who handle food to washtheir hands before doing so.

In Northumberland 21 cases in all have recentlybeen reported. The Newcastle health department

states that none of the patients is now seriously illand that so far it has not been found possible totrace the source of the infection.

The Comprehensive Health VisitorSince 1929 the tendency has been for local

authorities to appoint health visitors, each of whomwill carry out all the duties of health visiting andnursing, including school nursing. In a paper pub-lished in the Journal of State Medicine for January,1938, Miss E. J. Moorehead, superintendent of healthvisitors at St. Helens, brings forward weighty objec-tions to this policy, but does not perhaps give duevalue to the three reasons why most medical officersof health favour it. The chief of these is that thedivorce of school medicine from child welfare inhibitsthe continuance of supervision-and supervision ofthe rearing of children is the main function of thehealth visitor. Miss Moorehead thinks it an advantageto dissociate preventive from curative nursing. Wedo not accept this argument, for when preventivework becomes clinical, being applied to individuals,its separation from curative work is artificial. Weagree that if health visitors are to do all publichealth nursing, their district must be limited ; but

people do not like unnecessarily many invaders oftheir homes and we submit that a district is betterserved by health visitors to each of whom a partof the area is assigned than by the same numberserving the whole in different capacities.

ABSORPTION OF FAT.-At a meeting of the Societyof Public Analysts and Other Analytical Chemists onFeb. 2nd, with Dr. G. Roche Lynch, the president,in the chair, Dr. A. C. Frazer read a paper on fat

absorption and metabolism. He presented evidencethat passage of fats through the walls of the smallintestine can take place without hydrolysis to fattyacids and glycerol. In cats such hydrolysis cannot occur,for there is no lipase in the intestines. In human beingslipase is present and part of the fats ingested penetratesthe intestinal walls as fatty acids, but a large proportionpenetrates unchanged. The fatty acid portion passes tothe fat depots by way of the portal vein, liver, and hepaticvein, but the unhydrolysed fat avoids the liver and passesto the fat depots by way of the lacteal lymphatics and thesystemic vessels. The presence of particles of unhydro-lysed fat in the blood was detected microscopically byuse of dark-ground illumination, and this means was usedto study variations in the concentration of the fat particlesin the blood in course of digestion.