of 2 /2
1088 ending Sept. 20th, and presided over in the absence of the chairman of the Quebec Board of Health, Dr. E. P. Lachapelle, by its secretary, Dr. E. Pelletier. Dr. J. E. Laberge, of Montreal, insisted that instruction in hygiene should be made compulsory in all the schools of the province. He outlined 12 lessons, which could be subdivided into four parts, so that ample time could be devoted to all phases of the subject. At an evening session, Dr. T. A. Starkey, Professor of Hygiene in McGill University, gave a public lecture on the Responsibility of Municipalities in carrying out Sanitary Measures, which was followed by another lecture by Dr. C. N. Valin, Professor of Hygiene in Laval University, on the Advantages of Public Hygiene. Dr. A. Simard, of Quebec City, dealing with infant mortality, said that at least 2000 babes could be saved from death in that province with better care, proper sanitation, and hygiene. The conference also advocated the proper medical inspection and supervision of school children in all the I elementary schools of the province. Public Health Legislation in the Province of Qzeebe.e. The Provincial Board of Health of the Province of Quebec was first organised in 1887, Dr. Lachapelle, of Montreal, being appointed president, and Dr. Pelletier, of Quebec City, secretary. After 26 years these two o officers still continue in control of health matters in that province and to them is due the credit of the excellent Public Health Acts now in force. The board consists of nine members, four of whom must be physicians. In 1910 it was decided to divide the province into ten health districts, and six of these districts have since been organised with medical men in charge located in each district. All medical inspectors are required to hold a diploma of public health and to pass an examination prescribed by the Board of Health. Special attention is given to small-pox-always a menace throughout that province-and the Vaccination Act provides for vaccination in the first year after birth, and revaccination both in the eleventh ’and twenty-first years. During the present year in Montreal there have been 222 cases of small-pox-March heading the list with 51-and 1204 cases of tuberculosis-967 pulmonary and 237 of other forms. Insanity in Quebec and Ontario. In the Province of Quebec the care of the insane is under somewhat peculiar conditions, being entrusted to corporate bodies, religious or otherwise, by the Government, which makes a per capita grant for the public patients, who are allotted to the different institutions as follows : St. Jean de Dieu, 2000; Quebec Hospital for the Insane, 1257 ; Verdun Protestant Hospital, 515; St. Ferdinand Hospital, 145 ; St. Anne Hospital, 123-a total of 4040 public patients. Only Verdun makes returns of its private patients, and these number practically the same as the public patients. If the ratio in others is the same the officially insane in that province would approximate 8000. The amount paid by the Government for the public patients is$460,738.36. For the Roman Catholic institutions this is$112 per capita, while for the Verdun patients it is$142. Quebec has a total population of 2,000,000. In Ontario for the last official year the total number of insane in the provincial institutions was 5726, 2769 being males and the rest females, a net increase of 86 for the year. The admissions for the year totalled 1247, an increase of 103 ; the deaths, 460, an increase of 45; and the discharges, 570, an increase of 28. The number of deporta- tions was 258, an increase of 32, 66 being insane, 49 criminal, and 48 likely to become a charge upon the province. Manual and health work has been found most beneficial in lessening mental degeneracy, and a high standard of efficiency has been reached in the various institutions. The growth of insanity in the province is seen in the following statistics: 1882 to 1886, total 2775; in 1891, 3201 ; 1895, 3865 ; 1901, 4604 ; 1906, 4933 ; 1912, 5517. Of the 1247 admitted in the past year 890 inherited a predisposition. Of the admissions of the year 653 were men and 594 women, of whom 543 were single, 587 married, 116 widowed, and 1 divorced. Dominion Medioal Council Matters. ] At the tirst examinations of the Dominion Medical Council held in Montreal on Sept. 7th some 66 candidates presented themselves. At the recent annual meeting the Ontario Medical Council instructed its registrar to accept Dominion J registration as fall qualification for licence in Ontario, subject only to the production of the necessary credentials and payment of the usual fee. Four provinces have now established reciprocity with Great Britain—namely, Quebec, Prince Edward Island, Nova Scotia, and New Brunswick. Only one province, British Columbia, has failed to comply with all the requirements of the Dominion Act. It retains the right to examine candidates for subsequent licence in that province in the final branches. Sept.23rd. _________________ NOTES FROM SOUTH AFRICA. (FROM OUR OWN CORRESPONDENT.) Immigration Regulations. A SERIES of regulations has recently been promulgated under the Union Immigration Act passed last session, Under these regulations the port health officer or other duly appointed medical practitioner is to be present at the exa- mination of passengers by the immigration officer and to indicate any passenger whom he deems it necessary to examine medically before he is passed as an immigrant. Leprosy, trachoma, favus, framboesia, syphilis, and scabies are declared loathsome diseases, bringing those suffer- ing therefrom under the category of prohibited immi- grants. The regulations provide that persons suffering from tuberculosis may be allowed to land under a permit from the immigration officer, but these permits are only to be issued at the ports of Cape Town and Durban, and on the following conditions. The place of residence and the mode of transport thereto to be subject to the approval of the immigration officer, the immigrant to report himself to the local health authority at his place of residence, and to present himself for examina- tion by the district surgeon or other approved medical practitioner whenever required ; sleeping accommodation never to be shared with any other person, and regulations by the local health authority for preventing infection to others to be observed. It is clearly the policy of the Government to discourage the entry into the Union of tuberculous persons, although very little is being done to prevent the spread of the disease in the subcontinent itself. But with no properly organised health department the regulations are likely to be applied improperly or to become a dead letter. Reorganisation of Hospital Work in the Cape Peninsuta. The Cape Hospital Board has appointed a committee of inquiry to advise as to the requirements of the Oape Peninsula and the reorganisation of work under the new regime. The committee having sought the advice of the Cape of Good Hope (Western) Branch of the British Medical Association, the Association approved the formation of a clinical medical school, but as that would require some years of preparation it recommended that the board keep steadily in view the provision of a large hospital for the university medical faculty. It recommended the early establishment of a pathological department under the control of a univer- sity medical faculty, and considered it desirable that the New Somerset Hospital should be entirely reserved for free patients with a view to its development into a teach- ing hospital, though the site of that hospital is hardly ideal, not being in the neighbourhood of the medical school. It recommended that the honorary staff should be specialised and the principle gradually introduced of requiring the staff to restrict themselves in private practice to their specialty. Also that, when a complete medical course was established, beds should be reserved for the university professors, and that in the mean- time all holders of appointments as honorary visiting medical officers be selected by a mixed committee represent- ing the lay board, the honorary staff, and the outside profes- sion. It further recommended that free out-patients be treated at both the New Somerset Hospital and the Free Dispensary by an honorary out-patient staff appointed for the purpose; that the four suburban hospitals should, as at present, be conducted on the lines of cottage hospitals. that maternity blocks should be attached to the teaching hospital ; and that an entirely new.nospitalon the small ward system should be built in as central a position as possible for contributing patients. Finally, it stated emphatically

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ending Sept. 20th, and presided over in the absence of thechairman of the Quebec Board of Health, Dr. E. P.Lachapelle, by its secretary, Dr. E. Pelletier. Dr. J. E.

Laberge, of Montreal, insisted that instruction in hygieneshould be made compulsory in all the schools of the province.He outlined 12 lessons, which could be subdivided intofour parts, so that ample time could be devoted to all

phases of the subject. At an evening session, Dr. T. A.

Starkey, Professor of Hygiene in McGill University, gave apublic lecture on the Responsibility of Municipalities incarrying out Sanitary Measures, which was followed byanother lecture by Dr. C. N. Valin, Professor of Hygiene inLaval University, on the Advantages of Public Hygiene.Dr. A. Simard, of Quebec City, dealing with infant mortality,said that at least 2000 babes could be saved from death inthat province with better care, proper sanitation, andhygiene. The conference also advocated the proper medicalinspection and supervision of school children in all the

Ielementary schools of the province.Public Health Legislation in the Province of Qzeebe.e.

The Provincial Board of Health of the Province ofQuebec was first organised in 1887, Dr. Lachapelle, ofMontreal, being appointed president, and Dr. Pelletier,of Quebec City, secretary. After 26 years these two oofficers still continue in control of health matters in that

province and to them is due the credit of the excellent PublicHealth Acts now in force. The board consists of ninemembers, four of whom must be physicians. In 1910 itwas decided to divide the province into ten health districts,and six of these districts have since been organised withmedical men in charge located in each district. All medical

inspectors are required to hold a diploma of public healthand to pass an examination prescribed by the Board ofHealth. Special attention is given to small-pox-always amenace throughout that province-and the Vaccination Actprovides for vaccination in the first year after birth, andrevaccination both in the eleventh ’and twenty-first years.During the present year in Montreal there have been 222cases of small-pox-March heading the list with 51-and1204 cases of tuberculosis-967 pulmonary and 237 of otherforms.

Insanity in Quebec and Ontario.In the Province of Quebec the care of the insane is under

somewhat peculiar conditions, being entrusted to corporatebodies, religious or otherwise, by the Government, whichmakes a per capita grant for the public patients, who areallotted to the different institutions as follows : St. Jeande Dieu, 2000; Quebec Hospital for the Insane, 1257 ;Verdun Protestant Hospital, 515; St. Ferdinand Hospital,145 ; St. Anne Hospital, 123-a total of 4040 publicpatients. Only Verdun makes returns of its private patients,and these number practically the same as the public patients.If the ratio in others is the same the officially insane in thatprovince would approximate 8000. The amount paid by theGovernment for the public patients is$460,738.36. For theRoman Catholic institutions this is$112 per capita, while forthe Verdun patients it is$142. Quebec has a total populationof 2,000,000.

In Ontario for the last official year the total numberof insane in the provincial institutions was 5726, 2769being males and the rest females, a net increase of 86 forthe year. The admissions for the year totalled 1247, an

increase of 103 ; the deaths, 460, an increase of 45; and thedischarges, 570, an increase of 28. The number of deporta-tions was 258, an increase of 32, 66 being insane, 49criminal, and 48 likely to become a charge upon the province.Manual and health work has been found most beneficial in

lessening mental degeneracy, and a high standard of

efficiency has been reached in the various institutions. The

growth of insanity in the province is seen in the followingstatistics: 1882 to 1886, total 2775; in 1891, 3201 ; 1895,3865 ; 1901, 4604 ; 1906, 4933 ; 1912, 5517. Of the 1247admitted in the past year 890 inherited a predisposition. Of the admissions of the year 653 were men and 594 women,of whom 543 were single, 587 married, 116 widowed, and 1divorced.

Dominion Medioal Council Matters. ]

At the tirst examinations of the Dominion Medical Council held in Montreal on Sept. 7th some 66 candidates presented themselves. At the recent annual meeting the Ontario Medical Council instructed its registrar to accept Dominion J

registration as fall qualification for licence in Ontario,subject only to the production of the necessary credentialsand payment of the usual fee. Four provinces have nowestablished reciprocity with Great Britain—namely, Quebec,Prince Edward Island, Nova Scotia, and New Brunswick.Only one province, British Columbia, has failed to complywith all the requirements of the Dominion Act. It retainsthe right to examine candidates for subsequent licence inthat province in the final branches.

Sept.23rd. _________________

NOTES FROM SOUTH AFRICA.

(FROM OUR OWN CORRESPONDENT.)

Immigration Regulations.A SERIES of regulations has recently been promulgated

under the Union Immigration Act passed last session,Under these regulations the port health officer or other dulyappointed medical practitioner is to be present at the exa-mination of passengers by the immigration officer and toindicate any passenger whom he deems it necessary toexamine medically before he is passed as an immigrant.Leprosy, trachoma, favus, framboesia, syphilis, and scabiesare declared loathsome diseases, bringing those suffer-

ing therefrom under the category of prohibited immi-

grants. The regulations provide that persons sufferingfrom tuberculosis may be allowed to land under a

permit from the immigration officer, but these permitsare only to be issued at the ports of Cape Townand Durban, and on the following conditions. Theplace of residence and the mode of transport thereto tobe subject to the approval of the immigration officer, theimmigrant to report himself to the local health authority athis place of residence, and to present himself for examina-tion by the district surgeon or other approved medicalpractitioner whenever required ; sleeping accommodationnever to be shared with any other person, and regulations bythe local health authority for preventing infection to othersto be observed. It is clearly the policy of the Governmentto discourage the entry into the Union of tuberculous

persons, although very little is being done to prevent thespread of the disease in the subcontinent itself. But withno properly organised health department the regulations arelikely to be applied improperly or to become a dead letter.

Reorganisation of Hospital Work in the Cape Peninsuta.The Cape Hospital Board has appointed a committee of

inquiry to advise as to the requirements of the OapePeninsula and the reorganisation of work under the newregime. The committee having sought the advice of theCape of Good Hope (Western) Branch of the British MedicalAssociation, the Association approved the formation of aclinical medical school, but as that would require some yearsof preparation it recommended that the board keep steadilyin view the provision of a large hospital for the universitymedical faculty. It recommended the early establishmentof a pathological department under the control of a univer-sity medical faculty, and considered it desirable that theNew Somerset Hospital should be entirely reserved for freepatients with a view to its development into a teach-ing hospital, though the site of that hospital is hardlyideal, not being in the neighbourhood of the medicalschool. It recommended that the honorary staff shouldbe specialised and the principle gradually introducedof requiring the staff to restrict themselves in privatepractice to their specialty. Also that, when a completemedical course was established, beds should be reservedfor the university professors, and that in the mean-

time all holders of appointments as honorary visitingmedical officers be selected by a mixed committee represent-ing the lay board, the honorary staff, and the outside profes-sion. It further recommended that free out-patients betreated at both the New Somerset Hospital and the FreeDispensary by an honorary out-patient staff appointed forthe purpose; that the four suburban hospitals should, as atpresent, be conducted on the lines of cottage hospitals. that maternity blocks should be attached to the teachinghospital ; and that an entirely new.nospitalon the small wardsystem should be built in as central a position as possiblefor contributing patients. Finally, it stated emphatically

Page 2: NOTES FROM SOUTH AFRICA

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the opinion that it was unnecessary for the board to make ,provision for fully paying patients.

South African District Surgeons’ Association.At a meeting of the district surgeons representing all

provinces of the Union recently held at East London, onthe suggestion of the Transvaal District Surgeons’ Associa-tion it was unanimously agreed to form a South AfricanDistrict Surgeons’ Association, with a local committee in,each province. The following provisional committee wasappointed: Dr. Grinsell (Stutterheim) and Dr. E. G.Dru Drury (Grahamstown), representing the Cape Province;Dr. D. Campbell Watt (Pietermaritzburg) and Dr. J.Dodd (Ixopo), representing Natal; Dr. Moorhead (Rusten-burg) and Dr. Nixon (Heidelberg), representing the Trans-vaal ; and Dr. D. M. Tomory (Bloemfontein) and Dr.P. D. Strachan (Philippolis), representing the OrangeFree State. Dr. Campbell Watt was unanimously electedthe first president and Dr. Moorhead vice-president,and Mr. W. A. J. Cameron, of Johannesburg, a temporarysecretary. The rectification of the grievances of districtsurgeons under the existing regulations, and the contem-plated promulgating of new regulations curtailing many ofthe existing fees, were the determining causes of the newassociation.

Railway Sick, Fund Regulations.The long awaited new regulations for the administration

of the Railway Sick Fund under Union are at last gazetted.The control of the fund is to be in the hands of a centralboard of 16 members, half to be nominated by the adminis-tration and half elected by contributors. No provision ismade for medical representation, although it is possible thatthe administration may intend to nominate one or twomedical men as their representatives. Subordinate to theboard are to be four district boards with offices respectivelyat Cape Town, Bloemfontein, Johannesburg, and Durban.On these also there is no specific provision for medical

representation. The objections to the regulations are verynumerous. The new regulations are understood to have beencompiled without reference to contributors to the fund, tothe medical men concerned, or to the medical profession.It is of the utmost importance to the railway employeesthat their medical service should be an efficient one.

The medical officer has hard work to do his dutyboth to the railway administration and to the patient.It is utterly impracticable for laymen unassisted byprofessional advice to draw up satisfactory regulations ;yet this is what the railway administration has endeavouredto do. The new regulations are perhaps objected to morestrongly in Natal than elsewhere. At a meeting of theDurban branch of the British Medical Association recently con-vened to consider the terms offered by Government for medicalofficers to the new Railway Sick Fund, Dr. R. K. Howdenstated that he had been offered the appointment as railwaymedical officer to the Greyville district. There were 2380(estimated) railway workers in this district, including wivesand children of the actual employees. He was offered L500per annum. A few extras were allowed, the chief being£2 2s. for midwifery cases and L 1 Is. for anaesthetics and forconsultations ; also a travelling allowance of 8d. per hourwhen absent from headquarters on duty. He had worked out theremuneration offered, and it came to slightly less than 4s. 2d.per head per annum. With women and children included a fairestimate of the incidence of sickness would be 3 per cent.,giving about 60 attendances per diem. This was more thanone man could manage, and if an assistant and two motor-cars were kept it would all have to come out of the £500 per.annum. Dr. Howden further pointed out that the majorityof these people had previously been private patients, so thatpractices would be broken up and for ridiculously low ratesof payment. He might well also have added that in addi-tion there would be interminable correspondence connectedwith such a post. From the general discussion it was

evidently the consensus of opinion that the terms were totallyinadequate and should be strenuously resisted. Eventuallyresolutions were agreed to calling for conference with otherbranches as to their attitude, standing by the 12s. minimumrate for adult workers and adopting the principle of freechoice of doctor, and informing the Central Board thatmembers of the branch would not be allowed to negotiateindividually for the posts of railway medical officer untilterms were accepted by the branch and inviting a conference

between the board and the branch. Dr. Howden, Mr. S.Copley, Mr. B. A. Nicol, Dr. A. McKenzie, and Dr. DuncanMcKenzie were appointed a committee to deal with the matterand, if necessary, to meet a delegation from the sick fundand to report to the branch. The firm stand taken up by theDurban practitioners is very satisfactory.Sept. 5th.

NOTES FROM INDIA.

(FROM OUR OWN CORRESPONDENTS.)

Medical Research in India.THE first number of the new Indian Journal of Medioal

Research, edited by the Director-General of the IndianMedical Service and the Sanitary Commissioner with theGovernment of India, is now under issue as a quarterly.It is published for the Indian Research Fund Associationand takes the place of the Scientific Memoirs. Sir HarcourtButler in a foreword says : ’’ The time has come for the fundto have its own official organ, and the Journal should be aworthy record of what is being done in India for the advanceof sanitary science in the widest sense of the term." Itspages will be open to all, official and non-official alike, forpapers on subjects of research connected with medical andsanitary science. It is added that research work is rapidlydeveloping in India, and Sir Harcourt Butler makes anearnest appeal to all who are interested in it to support thejournal and enable it to hold a high place among thescientific journals of the world. The first number contains16 articles dealing, amongst other things, with cholera,kala-azar, dysentery, latent malaria, &c. Photographicreproductions of certain biting insects are beautifully done.The journal, which is published by Messrs. Thacker, Spink,and Co., of Calcutta, is admirably printed on thick paper.Its price is six rupees per annum.

Hospital Accommodation in Cochin.The Anglo-Indian community of Cochin, numbering over

3000, are making arrangements to memorialise the MadrasGoverment, through the local municipal chairman, to recon-sider its decision to omit the proposed European and Eurasianward from the estimate of the new Municipal Hospital sub-mitted by the local civil surgeon.

Infant Mortality in Bengal.In the annual report of the Sanitary Commissioner for

1912, just published, it is stated that nearly 340,000 childrenunder one year died in Bengal, representing a loss of 21 percent. of the births. The figures for 1911 were just under310,000. Calcutta has hitherto returned the highest infantdeath-rate-26 per cent. of births-but Jalpaiguri, with28 - 69 per cent., and Dinajpur, with 26 - 26, are now worse.Cholera and fever have been prevalent, but infant mortalityis not largely due to these diseases, but to ignorance ofhygiene and want of skilled medical treatment.

Child Life in Calcutta.A correspondent of a Calcutta paper draws attention to

the fact that little children are employed in the city todescend the drains and clean them. The corporation shouldtake the matter up and substitute more humane and up-to-date methods of cleaning the drains of the city.

The Drainage of Imperial Delhi.The scheme for the training of the Jumna at Delhi is to be

prepared in due course. The engineering difficulties are notlikely to be great, and with the services available of expertsin river training in India the work should be completed intwo or three years. When once the Jumna has been" trained " it can be kept to channels that will leave the areanow liable to flooding high and dry all the year round.

Amb2clanoe Work in India.General Haji Hafiz Obeidullah Khan, C.S.I., Imperial

Service Lancers, has signified his intention of presenting anambulance challenge shield to the Indian Council of theSt. John Ambulance Association for competition amongthe units of the St. John Ambulance Brigade in India andBurma.

° Tube Wells in India.

Experiments with tube wells in India are still being