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ROYAL COLLEGE OF PHYSICIANS.
663 . eesspools, and ought to be closed. The source of the water- that has been suggested. The view that seemed most supply extends over a considerable area of down country, plausible to us was, that a case of typhoid fever might have and the water furnished by the springs is of excellent occurred in one of the numerous homesteads scattered over quality and very free from organic impurity. The total the extensive down district from which the springs arise hardness is equal to fifteen degrees, and the permanent which supply the reservoirs, and the excreta, percolating hardness to three degrees, of Clark’s scale. The water is downwards, may have entered these and contaminated them. collected in two capacious reservoirs, and is filtered before There are, we know, formidable objections to be urged distribution. We were not able to ascertain by personal against this view, but still we think, if the investigations
I
observation the sanitary condition of the dwellings of the now being carried on fail to elucidate the cause, a strict middle classes, but we were informed that the house-to- inquiry into the health of the individuals inhabiting these house inspection originated by the high constable and the homesteads during the last six months ought to be instimedical officer of health showed that in most of the houses tuted. in working no care had been taken to keep the traps &c. In conclusion, we may state that the chief-constable and order. The homes of the poorer residents were, we thought, the medical officer of health, under the direction of the decidedly above the average, both in respect of accommo- Government Inspeci,or, Dr. Thorne, are carefully sifting dation and cleanliness. Lewes enjoys the reputationevery particle of evidence, and are sparing neither time nor of being an extremely healthy town, no great epidemic expense in their efforts to ascertain the cause. We conhaving occurred for nearly forty years. Last autumn, how. gratulate the town on the public spirit displayed by the ever, a slight but marked outbreak of enteric fever toolz authorities and on the vigorous measures they have adopted T)1 a nc. for stamping out the disease. Their conduct stands in The history of the present epidemic dates from the latterr strong contrast to the apathy and indifference exhibited by end of July in the present year, when an inmate of theB the corporations of such towns as Wolverhampton, Camgaol, who had been some time imprisoned, died of heemor- bridge, and Over Darwen under similar circumstances. rhage from the bowels after a febrile attack. There is every reason to believe this was a typhoid case, though, owing to the gaol surgeon being absent on his holiday, no distinct ROYAL COLLEGE OF PHYSICIANS. history of the illness can be obtained. The gaol has a constant from the town waterand separate water-supply A MEETING of the Royal College of Physicians was held works, and its sewage does not pass into the town drains. During the first week of August, six or seven cases occurred on Thursday, the 29th ultimo. in different parts of the town, all of whom either had the The President announced that the forthcoming Gulstonian company’s water in their houses, or had used it. One case lectures would be delivered by Dr. Robert Lee, the Croonian in particular, a lad living in Southover, with his family and the Dr. Lionel Beale. Dr. Lumleian Greenhow, by seven in number, all of whom drank well-water, was seizec by A further report, received through the India Office, rewith fever, and it was found that he alone had been in th( habit of drinking freely of the company’s water, when at lative to the treatment of leprosy by gurjun oil in the work in the town. Indeed, all the cases occurring during Andaman Islands, was read. It contained additional facts the first fortnight of August are distinctly connected with in of the efficacy of this mode of treatment. It testimony the water service. Then came a lull in the epidemic, but was ordered to be entered on the minutes for purposes of to out afresh in In break October. this second only early outbreak, the cases were not so closely connected with the: reference. water service, many being attacked who got their water The Registrar then read a communication from the Reelsewhere. In both instances the stress of the disease fell gistrar-General, relative to the new statute in regard to on the higher parts of the town and the better class of incertificates of death, which will come into operation in. habitants, the lower districts and the poor suffering but January, 1875. It was stated that since the Registration little. We found it difficult to obtain an exact statement of hasbeen in operation, in only 5 or 6 per cent. of cases the number of cases under treatment during the epidemic, have the causes of fatal diseases been uncertified by qualibut those best able to judge estimated them at 250 and 300. fied persons. The Registrar-General asked for the aid of£ Up to Monday, there ha.d been sixteen deaths. The epidemic the College in perfecting the form of certificate about to be appears to be declining, the recent cases being of a milder issued, nd for any suggestions the College might think tomake relative to the names of diseases and type. If we had only to account for the origin of the disease inI other points. A discussion took place on the question of the secondary ’cases, our task would be easy. There had payment of practitioners for the trouble of certifying the been cases of typhoid in the town a short time previously; cause of death. the excreta from these had passed into the drains, and in Sir Wm. Gull urged that no one should be compelled to due time the sewer gas had found its way into the dwelling- give of death gratuitously, and he was supported houses, and the fsecal matter into the wells, the consequence by Dr. Stewart and others, and the President was requested being an extensive diffusion of typhoid amongst those by the College to represent to the Registrar-General that brought within range of their injurious influences. But our some honorarium should be given to medical practitioners difficulty is to explain the origin of the disease in the primary for certificates of death. The suddenness of the outbreak in the early part of cases. August, and the number of persons affected almost simultaneously in different parts of the town, would lead us to OBSTETRIC FEES. the conclusion that the poison was introduced into the town somewhere about the middle of July; and seeing the AT the Clerkenwell County Court, before Mr. Gordon close connexion of the cases with the Company’s waterservice, it is reasonable to suppose it was distributed by Whitbread, Judge, a case of interest to the profession was that medium. And if we accept the gaol case as one of recently decided. "The plaintiff was lllr. Husband, of Stroudtyphoid fever, the supposition is strengthened, since N., and the defendant Mr. John Sworder, a the gaol and town received the same water, though by green-road, clerk. It from the evidence of the plaintiff that appeared distinct services. We may state here that the possibility of the poison being distributed by contaminated milk has whilst attending the case of Mrs. S a lodger in the been thoroughly discussed, and the evidence obtained was house of Mr. Sworder, Mrs. Sworder engaged the plaintiff strongly against such a supposition. Nor can the fever to attend her in July, when she expected her confinement. be attributed to the emptying or uncovering of any cess- Finding that the wife of the defendant had been confined his being sent for, the plaintiff instituted the prepool or drain, since the outbreak occurring in so many different and widely distinct parts of the town shows the con- sent proceedings. The defence was that the defendant had tamination must have been general, and not due to any never authorised the engagement of the plaintiff, and that his wife had acted without his authority. His Honour, M purely local cause. It is easy to suggest many ways in which typhoid matter summing up the case, remarked that as the plaintiff haè could have found access to the Company’s works. But the not seen the husband and asked his permission to attend hù evidence hitherto collected has failed to support any theory wife. he must be nonsuited. Verdict accordingly. -
-
I
I Act
desirable
certificates
bothI
without
I
observation the sanitary condition of the dwellings of the now being carried on fail to elucidate the cause, a strict middle classes, but we were informed that the house-to- inquiry into the health of the individuals inhabiting these house inspection originated by the high constable and the homesteads during the last six months ought to be instimedical officer of health showed that in most of the houses tuted. in working no care had been taken to keep the traps &c. In conclusion, we may state that the chief-constable and order. The homes of the poorer residents were, we thought, the medical officer of health, under the direction of the decidedly above the average, both in respect of accommo- Government Inspeci,or, Dr. Thorne, are carefully sifting dation and cleanliness. Lewes enjoys the reputationevery particle of evidence, and are sparing neither time nor of being an extremely healthy town, no great epidemic expense in their efforts to ascertain the cause. We conhaving occurred for nearly forty years. Last autumn, how. gratulate the town on the public spirit displayed by the ever, a slight but marked outbreak of enteric fever toolz authorities and on the vigorous measures they have adopted T)1 a nc. for stamping out the disease. Their conduct stands in The history of the present epidemic dates from the latterr strong contrast to the apathy and indifference exhibited by end of July in the present year, when an inmate of theB the corporations of such towns as Wolverhampton, Camgaol, who had been some time imprisoned, died of heemor- bridge, and Over Darwen under similar circumstances. rhage from the bowels after a febrile attack. There is every reason to believe this was a typhoid case, though, owing to the gaol surgeon being absent on his holiday, no distinct ROYAL COLLEGE OF PHYSICIANS. history of the illness can be obtained. The gaol has a constant from the town waterand separate water-supply A MEETING of the Royal College of Physicians was held works, and its sewage does not pass into the town drains. During the first week of August, six or seven cases occurred on Thursday, the 29th ultimo. in different parts of the town, all of whom either had the The President announced that the forthcoming Gulstonian company’s water in their houses, or had used it. One case lectures would be delivered by Dr. Robert Lee, the Croonian in particular, a lad living in Southover, with his family and the Dr. Lionel Beale. Dr. Lumleian Greenhow, by seven in number, all of whom drank well-water, was seizec by A further report, received through the India Office, rewith fever, and it was found that he alone had been in th( habit of drinking freely of the company’s water, when at lative to the treatment of leprosy by gurjun oil in the work in the town. Indeed, all the cases occurring during Andaman Islands, was read. It contained additional facts the first fortnight of August are distinctly connected with in of the efficacy of this mode of treatment. It testimony the water service. Then came a lull in the epidemic, but was ordered to be entered on the minutes for purposes of to out afresh in In break October. this second only early outbreak, the cases were not so closely connected with the: reference. water service, many being attacked who got their water The Registrar then read a communication from the Reelsewhere. In both instances the stress of the disease fell gistrar-General, relative to the new statute in regard to on the higher parts of the town and the better class of incertificates of death, which will come into operation in. habitants, the lower districts and the poor suffering but January, 1875. It was stated that since the Registration little. We found it difficult to obtain an exact statement of hasbeen in operation, in only 5 or 6 per cent. of cases the number of cases under treatment during the epidemic, have the causes of fatal diseases been uncertified by qualibut those best able to judge estimated them at 250 and 300. fied persons. The Registrar-General asked for the aid of£ Up to Monday, there ha.d been sixteen deaths. The epidemic the College in perfecting the form of certificate about to be appears to be declining, the recent cases being of a milder issued, nd for any suggestions the College might think tomake relative to the names of diseases and type. If we had only to account for the origin of the disease inI other points. A discussion took place on the question of the secondary ’cases, our task would be easy. There had payment of practitioners for the trouble of certifying the been cases of typhoid in the town a short time previously; cause of death. the excreta from these had passed into the drains, and in Sir Wm. Gull urged that no one should be compelled to due time the sewer gas had found its way into the dwelling- give of death gratuitously, and he was supported houses, and the fsecal matter into the wells, the consequence by Dr. Stewart and others, and the President was requested being an extensive diffusion of typhoid amongst those by the College to represent to the Registrar-General that brought within range of their injurious influences. But our some honorarium should be given to medical practitioners difficulty is to explain the origin of the disease in the primary for certificates of death. The suddenness of the outbreak in the early part of cases. August, and the number of persons affected almost simultaneously in different parts of the town, would lead us to OBSTETRIC FEES. the conclusion that the poison was introduced into the town somewhere about the middle of July; and seeing the AT the Clerkenwell County Court, before Mr. Gordon close connexion of the cases with the Company’s waterservice, it is reasonable to suppose it was distributed by Whitbread, Judge, a case of interest to the profession was that medium. And if we accept the gaol case as one of recently decided. "The plaintiff was lllr. Husband, of Stroudtyphoid fever, the supposition is strengthened, since N., and the defendant Mr. John Sworder, a the gaol and town received the same water, though by green-road, clerk. It from the evidence of the plaintiff that appeared distinct services. We may state here that the possibility of the poison being distributed by contaminated milk has whilst attending the case of Mrs. S a lodger in the been thoroughly discussed, and the evidence obtained was house of Mr. Sworder, Mrs. Sworder engaged the plaintiff strongly against such a supposition. Nor can the fever to attend her in July, when she expected her confinement. be attributed to the emptying or uncovering of any cess- Finding that the wife of the defendant had been confined his being sent for, the plaintiff instituted the prepool or drain, since the outbreak occurring in so many different and widely distinct parts of the town shows the con- sent proceedings. The defence was that the defendant had tamination must have been general, and not due to any never authorised the engagement of the plaintiff, and that his wife had acted without his authority. His Honour, M purely local cause. It is easy to suggest many ways in which typhoid matter summing up the case, remarked that as the plaintiff haè could have found access to the Company’s works. But the not seen the husband and asked his permission to attend hù evidence hitherto collected has failed to support any theory wife. he must be nonsuited. Verdict accordingly. -
-
I
I Act
desirable
certificates
bothI
without