Supplem1ent to The

SUPPLEM1ENT TO THE BRITISH M\IEDICAL JOURNAL LONDON SATURDAY DECEMBER 1 1956 CONTENTS Remuneration Claim 201 Petrol Rationing - --203 Coal Gas Poisoning - - 201 General Medical Services Committee 203 Forensic Medicine - - 202 Correspondence- -- 204 Library Opening Hours - -202 H.M. Forces Appointments - - - - 207 Prescription Charges- -203 Diary of Central Meetings - - - - 208 Sighthill Health Centre- - 203 Branch and Division Meetings to be Held 208 REMUNERATION CLAIM is higher, the number of casualties might be higher, and this assumption is being investigated by the Gas Council. During MINISTERS' REJECTION cold and windy weather when windows are closed and venti- The following letter has been received by Dr. A. Macrae, lation is diminished there is an increase in fatalities. While Secretary of the Negotiating Committee, from Sir John the percentage of carbon monoxide in coal gas may rise Hawton, Permanent Secretary to the Ministry of Health slightly at such times, this alone cannot account for the "On September 12 a memorandum was submitted setting out larger number of casualties. Thus decreased ventilation is a further particulars of the Negotiating Committee's views on the very important factor. legal aspects of the claim for increased remuneration. A comparison of the circumstances surrounding gas " I ani instructed to say that this memorandum has now been fully examined. MinisLers remain of the opinion that no con- poisoning deaths in 1934-8 and 1946-50 shows that the tractual obligation such as has been alleged by the Negotiating biggest percentage increase in the second five years over the Committee exists and that no action based on such a claim could first is due to taps being left open on lighting and cooking succeed If the Committee are not prepared to accept the burners (228 to 937 deaths, or 311%). The next highest Ministers' views as to this, no doubt the matter can be brought percentage increase concerned defective internal pipes, before the courts for adjudication." meters, and fittings (66 to 195 deaths, or 191 %). Deaths due The Negotiating Committee met on November 28 to to taps left open on fires increased from 99 to 269 (172%)' consider the Ministers' reply. and on cooking ovens from 154 to 442 (187%). Deaths associated with flexible tubing increased from 77 to 194 (152%) and deaths due to the mistaking of taps close together increased from 22 to 46 (109%). Escapes of gas outside the COAL-GAS POISONING home (that is, from main pipes) caused 47 deaths in the first B.M.A.'s INQUIRY five years and 82 in the second, an increase of 74.5%. On March 2, 1955, the Council empowered the Science Com- Deaths in industry decreased from 100 to 89 (11%). mittee to set up a subcommittee "'to inquire into the problem of accidental death and ill-health from coal-gas poisoning, Liability to Gas Poisoning and to make recommendations." At its meeting on Novem- Two groups of investigations specially made for the sub- ber 7 the Council approved the report,* and a summary of committee show how elderly people are particularly prone it follows. to fall victims to gas accidents. The first of these was a In recent years, the subcommittee found, there had been a survey of a sample of old people living in a metropolitan progressive increase in the number of accidental deaths from borough. Nearly all of them used gas cookers; some 19% coal-gas poisoning in Great Britain. In 1931 there were 175, of these required attention, though only 1{% (4) needed to in 1951 there were 589, and the provisional figure for 1955 be replaced because of serious defects. A rough assess- is 892. But the increase must be viewed in conjunction with ment of the old people's capabilities based in part on two facts-first the amount of gas sold in Great Britain has information from the subjects themselves suggested that increased by 85.7% during 1931-55, and the proportion of 10% were likely to be especially prone to accidents with old people in the population has also increased. gas appliances, owing to sensory or motor defects. The toxicity of the coal gas depends on the percentage The second group of investigations was to determine the of carbon monoxide in it. This varies in different parts of sensitivity of old people to the smell of town gas. Between the country and at different times. When and where toxicity, 40 and 50 patients of the geriatric unit of a London hospital were tested for their capacity to detect and identify the smell *The members of the subcommittee were: Dr. W. N. LEAK, of gas (as well as other odours). The subcommittee found general practitioner, police surgeon, division medical officer, I.C.I. (chairman). Dr. H. D. CHSLKE, medical officer of health, that the results had to be treated with some reserve, one Camherwell. and divicional medical officer, L.C.C. Professor reason being that some patients who were most anxious to ESTHER M. KILLICK, professor of lphysiology, University of Lon- please were prepared to smell gas in any mixture submitted don. Mr. J. R. NICHOL.SON-LAILEY, chairman of the Science Committee. Dr. A. LtOYD POTTFR. dixision medical officer, to them. Moreover, most of the patients were in bed and, I.C.I. Dr. C. KerrTH StMPSON. forensic pathologist, reader in did not find it easy to use the apparatus comfortably. The forensic medicine, University of London. Dr. F. H. TYRER, results suggested, however, that the minimum detectable con- chief medical oiflcer, West Midlands Gias Board. The subcom- centration of gas for women over the age of 65 is much mittee co-opted the following: Miss BERYL F. CROUCH, S.R.N., health visitor, L.C.C. Mr. G. H. FUIDGE, chief physicist, South- higher (2.5 parts per 1,000) than that for the age 20-50 (0.7 eastern Gas Board. parts per 1,000), and that the variation is very much greater. 2706 SUPPLEMENT TO THE 202 DEC. 1, 1956 COAL-GAS POISONING BRITISH MEDICAL JOURNAL (16) In the same way, doctors, district nurses, health visitors, Rescue and Prevention and others should be asked to notice the gas appliances used by aware of the The only safeguard for more than short exposures to gas their patients and be made of the willingness gas board to correct defect observed. is an air-line or oxygen breathing apparatus. A canister gas any mask is of strictly limited benefit. The main stop-cock in (17) All local authorities should do their utmost to see that the gas appliances of old people are properly suited to their require- every house should be within easy reach, windows and doors ments, and more use should be made of statutory powers to should be opened immediately to allow gas to disperse, and achieve this result. bare lights or sparks must be avoided. Administration of (18) Educative but not alarmist publicity should be provided pure oxygen should be started as soon as possible and arti- through press, radio, and television to indicate the dangers in ficial respiration performed if necessary. The subcommittee the use of coal gas, particularly to the aged and infirm, and also suggests that every fire and ambulance station should be to explain how easily many of these dangers can be avoided. provided with a mechanical respirator. The Gas Council is The public should be induced to demand and suppliers urged to provide safety devices which comply with the standards of estab- studying the possibility of giving gas a more pungent smell, lished safe but it is thought that tear gas would be ineffective as a practice. warning when people were asleep, and a sneezing substance might increase the risk of bronchial trouble after exposure to gas. Communal meters-a known danger-are being rapidly FORENSIC MEDICINE replaced. Taps which have to be pushed in before they can The Forensic Medicine Subcommittee of the Private be turned are the safest type. Various automatic devices are Practice Committee met recently and reappointed Dr. being studied or are already on the market to ensure that D. TEARE as its chairman for the session. when gas is emitted it shall be lit. The law makes it man- datory on the local authority to look after the health and Mileage Allowance welfare of old people, and any changes required to make In connexion with the Coroners (Fees and Allowances) gas appliances safer and more handy for these people would Rules, 1955, it was learnt that the Home Office had expressed be a justifiable expense. The subcommittee's recommenda- doubt whether the provision of a travelling allowance for the tions are given verbatim below. performance of a necropsy could be made in a local authority schedule, as previously was the case. Following Recommendations representations made by the Subcommittee, it was under- (1) The main stop-cock to the gas supply in a house should stood that the Home Office now intended to amend these always be easily reached and well marked. Rules to provide for these travelling expenses. A deputa- (2) The precautions needed to promote safety in rescuing cases tion was appointed to attend the Home Office to urge that of coal-gas poisoning should be more widely known. these allowances should be in accordance with Association (3) Self-acting artificial respirators should be available at every policy. fire station and ambulance station. Model Schedule (4) Research should continue on the practicability of reducing An interview is to be with the associations of local the carbon monoxide content of coal and sought gas the influence of authorities to discuss a model schedule of fees, allowances, this on the incidence of coal-gas poisoning.

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