A.Campbell Munro
1884 The Lancet  
11 micturate, and these extended over some weeks. The S1 tumour remained in situ, however, and there has been no rl sign of its reappearance since. I cannot say, however, that o the operation has benefited the patient very much. She is h nearly as low-spirited as ever, and though there is less f abdominal pain than before, there is still a good deal, and the calls to micturate are still abnormally frequent. Post sibly the near advent of the menopause may partially explain her symptoms. o
more » ... .-I am no advocate of operative procedure in the a case of either movable or floating kidney, and what was p done in this case was rather as a sequel to an exploratory a operation than as a deliberate attempt at fixation of the t kidney. It would have been easy to stitch the kidney to s the abdominal wall; but it is difficult to believe that an unprotected position close to the surface of the abdomen and in I contact with its constantly moving walls can be much better t than free movement inside the abdominal cavity. Again, I { might have cut down on the kidney in the loin, and stitched ( its capsule to the tissues in the neighbourhood. This would ( have added to the danger of the operation, and would have 1 rendered only the immediate result more certain, for sutures ( fixate only as long as they exist. When these are absorbed, the adhesions only remain to connect the united surfaces, and if the artificially inflamed capsule is kept in position 1 while the adhesions consolidate the effect of sutures might i be got. In this case, now that a year has passed, we may i assume that the desired result has been attained. In another case I should give a thorough trial to treatment by rest in bed, and carefully applied padding inside an abdominal belt. If this failed, I should perform nephrorraphy by lumbar incision. But a case such as the above teaches us not be too sanguine as to the immediate good result of fixation, and should warn us to hold our hands for a long time unless the local symptoms were very urgent indeed. Clifton. AT a time when the question of the compulsory notification of infectious diseases is being hotly debated, and its extension to various individual towns vigorously opposed, it may be serviceable that some statement of the results of the adoption of the system in one of the towns in which it was nrst introduced should be laid before the profession. The Jarrow Improvement Act, which came into operation at the end of 1878, includes the following sections, which detail the conditions of the notification system as adopted by the corporation of that borough :-"35. In order to secure that due notice be given to the corporation of any inmate of any house who is suffering from infectious disease, the following provisions shall have effect (that is to say): (a) If any inmate be suffering from any such disease as aforesaid, the occupier or person having the management or control of such house shall, so soon as he becomes aware of the existence in any such inmate of any such disease, forthwith give notice thereof to the corporation. (b) If such inmate be not a member of the family of such occupier or person, then such inmate or the person having charge of such inmate shall, on becoming aware of the existence of such disease, forthwith give notice thereof to the corporation. (c) If such inmate so suffering as aforesaid is attended by a medical practitioner, such practitioner shall, on becoming aware that such inmate is suffering from any such disease as aforesaid, forthwith fill up, sign, and send to the corporation at the Town Hall a certificate or declaration stating, according to the forms prescribed and supplied to him by the corporation, the name of such inmate, the situation of such house, and the name of such occupier or person, and the nature of the disease from which inmate is suffering. (d) The corporation chall pay to every medical practitioner a fee of one shilling for every certificate or declaration given bv him under this section. Only one such fee shall be payable in the case of one and same illness in the same house or family. (e) The corporation shall provide and supply gratuitously to every registered medical practitioner resident or practising in the borough forms for the certificate or declaration by sucti medical practitioner of the particulars herein mentioned in relation to such cases, according to the form set forth in the schedule to this Act. In this section , house' includes any part of a house, and any building for the time being used for human habitation. " 36. Any person wilfully or without reasonable excuse offending against any provision of this part of this Act, or any order or regulation made under the provisions of this part of this Act, shall be liable on summary conviction to a penalty not exceeding five pounds, and in case of a continuing offence, to a further penalty not exceeding forty shillings for every day on which such offence continues." Infectious disease is defined in Section 2 of the Act as meaning "small-pox, cholera, and fever." It will be seen that the duty of notification is laid both upon the householder and the medical man; practically, the notifications are received from the medical men. It happens that in the series of annual reports of successive medical officers of health for the borough, published up to the present time, the zymotic death-rates 1 of the five years preceding, and the five years succeeding the adoption of the notification system are given. Quinquennial periods are, I think, sufficient to furnish fair bases of comparison and to ensure the elimination of fallacies arising out of individual years of exceptional epidemic influences, such influences, for instance, as the prevalence of particular zymotics in adjacent districts. The following is a statement of the zymotic death-rates per 1000 of the population during the last ten years. A simple calculation will show that the mean zymotic rate of the first or pre-notification period is 5'1, as compared with 3'8 in the period during which the notification system has been in force. The decrease-1'3 per 1000—in the mean zymotic rate of the second period, as compared with the first, is very gratifying. It will, however, be urged that there has been a considerable coincident decrease in zymotic rates all over the country. Such is indeed the case. I have tabulated below the zymotic rates in the fifty town districts with which Jarrow is included in the Registrar-General's returns, and with the zymotic rate of which that of Jarrow may most fairly be compared :— The mean of the first quinquennial period is 3'6, of the second, 2'8 ; the decrease in the zymotic rate of the second period as compared with the first was 0'8. It will be seen that the decline in the zymotic rate in Jarrow is almost double that of the fifty town districts.2 And the diminished prevalence of zymotic disease in Jarrow cannot be attributed in any degree to a proportional improvement in general sanitary conditions; the decline in the zymotic rate is not at all accompanied by a proportional decline in the general death-rate. The mean death-rate of the borough for the quinquennial period 1874-78 was 22 0 per 1000 ; for the period 1879-83 it was 20'5, the decrease being 1'5. Otherwise put, the proportion the decrease in the general deathrate bears to the mean death-rate of the first period is 0'068. while the decrease in the zvmotic rate is in the proportion of 0.254 to the zymotic rate of the first period. There may be towns in which in the same period a like gratifying decrease in zymotic rates has been experienced to that which has occurred in Jarrow ; but I can hardly believe 1 Death rates per 1000 of the population from the seven principal zymotic diseases. 2 It is almost certain that the population in Jarrow has increased at a much more rapid rate in the last three years than is estimated by the Registrar-General's method; if this under-estimation of the population were discounted, the decrease in the mean zymotic rate of the second quinquenniad would be fully double that of the fifty town district?. A 2
doi:10.1016/s0140-6736(02)23668-5 fatcat:s63dcgmyyjcohdtradnlhpjdey