THE GENERAL ELECTION AND POOR-LAW MEDICAL REFORM.

180 vened. I then made a representation to the chief magistrate, and sometimes took the law into my own hands, had the loch water turned off, and a smaller supply of purer water from another source let in, and always with the effect of staying the disease. This I had done at the commencement of the present epidemic, and I reported to the local .authority some ten days after that the number of cases had fallen to five. From that time the number of cases gradually increased until they reached twenty-seven. All the closes were washed with hot lime, the sewers treated with chloride of lime periodically, the middens all iremoved, and a sheet of instructions delivered to every householder in the borough. I called on one of theborough officials (the treasurer) and was assured that the offending water-supply was still shut off. I thought probably that those people had received the poison prior to the change, and had it not been for the schoolmaster calling on me with complaints as to the water he was getting, I should not have discovered that the old water had again been turned on, my own house being supplied from a different source. I again remonstrated, and had the water changed ;but as I plainly saw that my opinion as to the cause of the disease was looked on as a wild theory, I at once wrote to the Board of Supervision in Edinburgh to send across their medical officer to inquire and report upon the epidemic and its cause. This they did, and on the 2nd of January Dr. Littlejohn, the medical officer of health of the city of Edinburgh, visited Kinghorn, and with me first saw several cases, and then examined into the water-supplies and sewage system. In a long report which he made to the Board of Supervision, he concurs in my views as to the cause, and the Board has accordingly ordered the ’local authority to carry out the instructions - contained therein. For upwards of three years the necessity of Einghorn having a new water-supply has been the talk of the authorities, and now it will get it. It will now be properly drained, and, with good wholesome water, will again be looked on as a favourite bathing-place as in times gone by. From first to last there have been upwards of ninety I did - cases under treatment, and of all shades of severity. not see the most of the cases till the seventh or eighth day, and some as late as the thirteenth. The deaths numbered five, and three from typhus. In all cases where the pulse and thermometer were not high, a decided crisis occurred on the twenty-first day; in bad cases the fever continued for an indefinite period, evidently owing to the serious In three-fourths of the cases bowel lesion, bed-sores, &c. there was diarrhoea, and in about a fourth of these evacuation of blood; in the other fourth there was decided constipation. Believing with Dr. Maclagan, of Dundee, that diarrhoea is the more favourable state of matters, I never hesitated to give purgatives when required, using either castor oil or mercury with chalk, followed by rhubarb, and in no instance have I seen any bad results follow. I have had one death from perforation and two from excessive tsemorrhage, both of which occurred on the twenty-first day. Milk-and-water in bad cases were my form of support, with wine when necessary, and in other cases a little farinaceous food with milk. When the diarrhoea was very excessive and exhausting, I warmed the milk slightly, and added lime-water, with good results. At the present date there are but six cases remaining, the fall in the number since the changing of the water, three weeks ago, being steady, and only one new case presenting itself during the past week. It is to be hoped that now we shall have done with enteric ::fever, and, with such natural facilities at our disposal for sanitation, we should never see it again, at least in an epidemic form. I am. Sir. voura vours faithfullv. faitbfullv. JAS. WELSH, M.D., Medical Officer of Health. Kinghorn, Fife, N.B., Jan. 17th, 1874. P.S.-Since writing the above, I have seen your last issue, in which you notice the epidemic and the death of the Rev. James Jenkins. Mr. Jenkins, I learn from his friends, died on the nineteenth day of the fever from the excessive haemoxrhage. With the exception of Mr. Jenkins and two others, all the cases were confined to the working classes. I attribute this more to the difference in thoir respective habits than to anything else. As to age, the large majority of those attacked were between eighteen and twenty-five. I have

just learnt that some seventeen years ago a similar epidemic prevailed, which proved very fatal. Presuming that I am right as to the cause-the watersupply,-how is it that the same water should at one time

on this occasion cause enteric fever? There must be something atmospheric to have influenced it. In trying to explain the matter to my non-professional friends here in the local authority, I used as a simile the action of six grains and a sixth of a grain of calomel, and argued that sewage might in the same way vary as to its effects. Although tainted water was suspected to have been the agent in the production of fever, all the gullies in the sewers have been ordered to be trapped, and the sewage completed at the town head. The sanitary staff is to be increased, and new works towards an increased water-supply It is just four years since I sent are in active progress. in a voluntary report to the local authority on the watersupply, and foretelling then what has happened now. The only thing that surprises me is that it did not occur sooner.

produce diarrhoea and

J. W.

THE GENERAL ELECTION AND POOR-LAW MEDICAL REFORM. To the Editor of THE LANCET. SiR,-It is now several months since, through your

columns, I addressed my Poor-law medical brethren

on the of reform in branch of Poor-law that administration. subject I have been silent, as the conviction has been forced on me by the proceedings in St. Stephen’s during the last two years, and notably in the last session, that nothing in the shape of beneficial legislation was to be expected from the Parliament which has just come to an end, and I therefore considered it was not worth while to waste time and energy in what would have been profitless agitation. It was, however, my intention at an early date to have convened a general meeting of the Association for the purpose of arranging a concerted scheme of action at the general election which was known tobe imminent. The unexpected manner in which Mr. Gladstone has decreed a dissolution has deprived I have therefore no alternative me of that opportunity. but to ask you to permit me to remind the Poor-law Medical Service that there are three objects of the Association which have been repeatedly endorsed at our quarterly and general meetings, the advisability of supporting which should be pressed on the attention of candidates, and particularly on candidates for counties. They are1st. The entire instead of partial payment of salaries from the Consolidated Fund. 2nd. An amendment of the Superannuation Act, rendering it absolute on the part of boards of guardians, and that the amount should be determined previous to the officer tendering his resignation. 3rd. The extension to the rural districts of the dispensary system, which has been found to work so advantageously for the poor and the profession in the metropolis. If this is to be done effectively, it can only be by each Poor-law medical officer writing to the candidate for representation of his borough or county, immediately on reading this.

I

am.

Sir.

vours

obedientlv.

Dean-street, Soho, Jan. 28th, 1874.

JOS. ROGERS.

POOR-LAW MEDICAL OFFICERS AND MEDICAL OFFICERS OF HEALTH. - t0

the Editor of THE

JANCET.

SiR,-When the appointment of medical officer of health determined upon by our board of guardians, they sent for their district medical officers (six in all), and asked them if they were disposed to accept the appointment, each for his own district. It was then and there agreed that they should be appointed, and the salary which the present sanitary officer receives—=6250—be equally divided between them. Well, there was great satisfaction at having their past services acknowledged and the hope of being better paid in future, when, lo and behold ! down comes a notice from the Local Government Board refusing to allow the appointments, on what ground I know not, but I should was