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Annotations.DISPENSARY SUPERVISION OF TUBERCULOSIS

IN THE HOME.

,*No quid nimis."

THE administrative control of tuberculosis is a

problem deserving more than all the attention whichis being given to it. Dispensary supervision is oneof the simpler methods at present in use, and wewould direct attention to Dr. George Jessel’s articlein the last issue of THE LANCET, in which hesuggests that by suitable instruction, close super-vision, and the occasional help of care committeessome reasonable degree of sanatorium practice canbe obtained from the systematic dispensary super-vision of tuberculous patients in their own homes.His conclusion is that such home treatment is both"possible and safe" in dealing with 70 per cent.of the cases occurring in an industrial area of Lancashire. This proportion of the families con-cerned is able to provide a separate bedroom forthe tuberculous member. It will readily be agreedthat from home treatment under close supervisiona considerable measure of success is obtainablewith suitable patients in suitable homes in suitabledistricts. But it is always difficult to secure theproper regimen (including rest and exercise)and the necessary direction and supervision ofdetails. The medical officer is dependent uponthe intelligence and goodwill of the patientin carrying out instructions which cannot be

enforced, and entirely suitable patients and con-ditions for home treatment may be regarded asexceptional among the poorer classes. We thinkthat if the supervisory and stimulating visits ofthe medical officer and nurse or health visitor arenot more frequent than those indicated by Dr.

Jessel, the care of details will have a tendency torelax as the disease progresses, at a time when theneed for such care is steadily increasing. A fewmonths of previous training in a sanatorium and,when necessary and practicable, the provision of ashelter will certainly contribute materially to thenumber of instances in which home treatmentbecomes " possible and safe." It is to be hopedthat Dr. Jessel will be able to develop his thesisfurther, and more particularly in the direction of acareful study and record of the course of the

Idisease among his home-treated patients.

THE CONTROL OF UNDESIRABLE IMMIGRANTSIN THE UNITED STATES OF AMERICA.

THE methods of preventing the introduction ofepidemic disease at the Port of London were dealtwith recently by the medical officer in a lecture atthe Royal Institute of Public Health which wesummarise on p. 612. Similar measures are inforce in the United States of America. In 1912 Iquarantine authorities situated at the more

important U.S. Atlantic ports examined 34,000specimens of faeces from ship passengers andcrews coming from cholera-infected ports. At theNew York quarantine the cholera vibrio was I,isolated from 28 persons sick with the disease andfrom 27 healthy persons. Seven cases of cholerawere detected at other ports by the same methodsand the disease was kept out of the country.During the cholera epidemic in Germany of 1892-93the American authorities instituted an inspectionon foreign soil of everything to be imported to the I

United States. Officers of the United States PublicHealth Service stationed at foreign ports super-vised the water- and food-supply of departingvessels, as well as inspecting crew and passengers.Those coming from infected localities were detainedunder observation for five days before being per-mitted to embark. In the Philippines, sinceAmerican occupation, the inter-island spread ofcholera, which in the past took toll of so manylives, is checked by a careful sanitary supervisionof vessels at ports of departure and arrival. Extra-

ordinary measures were. taken a few years earlierto prevent the importation of bubonic plague.Under the direction of the U.S. Surgeon-GeneralPacific ports, notably San Francisco, were " cleanedup" ; the community was freed of rats by a "drive"that necessitated the employment of scores of

inspectors and which overlooked hardly a squarefoot of the city; the cooperation of the populace-was secured by explaining the danger to themthrough meetings at schools, workshops, andonlces and the daily press; quarantine precau-tions were increased. The plague was kept out..The public hygienic activities in the United Statesare not concentrated in the hands of one sanitarybureau. Some of the public health branches are apart of the U.S. Department of Agriculture, othersare in the Department of Commerce, and the most-important, the Public Health Service, is affiliatedto the Treasury Department. One of its functions.is the administration of the national maritime

quarantine and the medical inspection of immi-

grants. It also makes special investigations of infec-tious diseases in States when necessary, althougheach several State has its own department ofhealth. A large proportion of all persons engaged,in public health work, both official and voluntary,are members of the American Public Health Asso-ciation, which, while not an official organisation,contributes through its journal and regular meet-ings towards the general policy of dealing withcontagious diseases.

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SCARLET FEVER IN JOHANNESBURG.

THE recent report of the acting medical officerof health of Johannesburg discusses the undue-prevalence of scarlet fever in that city sinceOctober, 1917. The number of cases notified andthe number admitted to the Fever Hospital duringthe last two years are as follows :-

The epidemic decreased somewhat betweenFebruary and April of this year with a riseagain in June. In July the cases fell to255, and during the first 20 days of Augustonly 126 cases were notified, showing a dis-tinct tendency to decline of the epidemic. The

problem of isolation became a perplexing one.

The Johannesburg Nursing Home was opened atthe beginning of July as an overflow for convales-cent cases of scarlet fever, but soon after it wasopened a cross-infection of scarlet fever andmeasles occurred both at the Fever Hospital andat the Nursing Home. So that fresh cases’ of scarletfever could be admitted to neither. In consequenceit again became impossible to isolate a considerable