- Email: [email protected]
ANNUAL REPORT OF THE MEDICAL OFFICER OF THE LOCAL GOVERNMENT BOARD.1
1609 Thus up to Nov. 22nd, 35,902 copies of the Pharmacopceia and i that, by means of book entries and without the passing of cash, at the 4393 copies of the Addendum (including the Government of India end of the year the General Council, after repaying the loan from the
copies,
edition) have been so](1. The stock remaining in hand of the PharmaIt will, 1128 copies and of the Addendum 2001 copies. probably be necessary to print a fresh issue of the Pharmacopoeia before next November.
is
therefore,
The committee desire, on the retirement of Dr. Payne from the to record their grateful sense of the services which he rendered to the committee, especially in rclatiott to the formation and of its library of reference. arrangement Dr. Norman Moore has, at the request of the committee, undertaken of the library in the place of Dr. Payne. the charge The committee have received with satisfaction the appended communication and inclosures from the Privy Council respecting the proposed agreement on the subject of international uniformity in the pharmacopceial preparations of potent remedies. The successive stages in the negotiations on this subject are set forth in the minutes. That so large a measure of approval should have been accorded to the agreement by the signatory national authorities is a matter of It indicates that the proposals of the International Conference at Brussels have been deemed by the Governments of Europe and America to be both desirable and practicable. The committee will naturally keep in mind the terms of the agreement when they undertake the revision of the Pharmacopoeia of 1898. The committee have been placed in communication with the Secretary of State for the Colonies, and through the Privy Council with the Government of India, on the subject of the drugs and preparations sanctioned for Indian and Colonial use in the Addendum of 1900. A paper of inquiries has been drawn up hearing on the question of the ultimate inclusion of these and other articles in the Imperial Pharmacopeeia, and this paper has, by the courtesy of the Secretaries of State, been brought to the special notice of the various administrative authorities of the Empire. It is confidently expected that the replies to these inquiries will be of the greatest service to the committee at a later stage of their work on the Pharmacopoeia.
Council,
congratulation.
Dr. NORMAN MOORE seconded the motion which
agreed
was
to.
P’inance Committee’s
Report.
Dr. MACALISTER moved that the report of the Finance Committee be received and entered on the minutes as follows :I. The committee had before them the following approximate statements of the estimated receipts and expenditure to the end of the present year, showing at a glance the position of the General and Branch Councils and the Dental Fund :-
-
ùL.VV
The committee drew up the following report :-
It should be remembered that the "estimated contribution" from the branches is a sum fixed by the auclitors and based upon the expenditure of the three previous years. It may be (and this year prob-
ably will be) anticipated.
found that the actual expenditure is not so great as was The English and Scottish branches will not be able to pay their contributions in full out of income. The questions which appear to call for consideration are as
follows
:-
General Council.-There has been received from the builders next door .E1000 for C’oneessiolls made to them and for breach of agreement. This sum cannot rightly be considered income. If the General Council transfer ;;C1000 to the English Branch in reduction of the mortgage the English Branch can then transfer ;;C1000 to the General Council towards the deficit of its "estimated contribution." The result of this will be
I Pharmacopoeia
account and reducing the mortgage by £ 1000, will have small cash balance. Dental Fund.—There should be about .E17CO in hand at the end of the year provided that the English Branch repays its loan. II. The committee also considered a report relating to the provision of a new fireproof safe and the institution of a new system for filing documents in connexion with the Medical Register remitted to them by the Executive Committee at its meeting on Nov. 21st, 1904, under the following resolutions "That this report be remitted to the Finance Committee with the expression of the opinion of the Executive Committee that it is desirable that the suggestions in regard to the introduction of the new system and the provision of a new safe should be adopted and that the committee be requested to consider if there are any means of meeting the expense." RECOMMENDATIONS. I. That the General Council apply the £ 1000 received from the builders towards the reduction of the mortgage to the English Branch Council of the General Council’s property. II. That when the accounts of the Dental Fund for the year are made up, the available surplus standing to the credit of the fund be invested in Consols. III. That the funds to carry out the suggestions in the report be provided by means of a loan from the PharmaeoDceia account, bearing interest at 3 per cent., repayable by equal annual instalments over a period of five years. a
Dr. MCCALL ANDERSOX seconded the motion which
agreed
was
to.
The Council then
adjourned till Monday.
ANNUAL REPORT OF THE MEDICAL OFFICER OF THE LOCAL GOVERNMENT BOARD.1 FIRST NOTICE. No one can carefully study the report for 1902-03, which is that at present before us, without arriving at the conclusion that the traditions of the medical department of the Local Government Board with regard to thoroughly scientific inquiries and reports are being fully maintained under the existing regime. In fact, a study of this report makes us regret two things-firstly, that time does not allow of the production of more documents of an equally exhaustive nature ; and, secondly, that these reports of the medical department do not receive a wider circulation than is at present the case. Unfortunately, in one way, these reports are so thorough and comprehensive and are so well illustrated with plates, maps, and diagrams that the cost, although in no sense prohibitive, is such that the volumes are not likely to find their way to the private libraries of every medical officer of health throughout the country. We are afraid, too, that many of the smaller local authorities in this country will hesitate before providing their medical officers of health with this very necessary literature. Moreover, in a very large number of public health offices there is practically nothing to. which the name of a public health library could be properly applied. We think, however, that every medical officer of health should make application to the local authority for these volumes and that they should become not the private property of the medical officer of health but part of the library which should be found in the office of every sanitary authority. The report proper consists of an introduction addressed by the present medical officer, Mr. W. H. Power, C.B., F.R.S., to the President of the Local Government Board. This introduction, which practically summarises the medical inspectors’ reports which are contained in the volume in the form of an appendix, is admirable and it contains, we fear, as much expression of the personal opinion of Mr. Power as we are likely to get under the present system of administration. We confess, however, that it would be both inspiring and refreshing if we could have the benefit of the medical officer’s views upon questions such as the provision of isolation hospitals, the value of sanatoriums for pulmonary tuberculosis, and other problems concerning which the outside public health service would be glad of the light which Mr. Power could undoubtedly throw upon them were he free to express his views. And now as regards the actual contents of the current volume.
1 Thirty-second Annual Report of the Local Government Board 1902-03. Supplement containing the reportof the medical officer for 1902-03. London : Eyre and Spottiswoode. 1904. Pp. li.-709, with maps and illustrations. Price 8s.3d.
1610 In the matter of vaccination it is encouraging to find that the figures for 1901, which are those here dealt with, show that the improvement which was noticed in 1898 has been almost continuously maintained and that the percentage of children remaining unvaccinated, which in 1898 was 26’6, has. been in succeeding years up to 1901 26’8, 19’9, and 17’3 per cent., and such increase in vaccination has been on the whole general throughout the country. There have been an increase of infantile vaccination in all the 43 counties of England and a decrease during the " same period of conscientious objection" in 50 per cent. of to learn that the such counties. It is also National Glycerinated Calf Lymph Establishment has been equal to the demands which were made upon it during 1902-03 by public vaccinators. Some idea of such demand may be gathered from the facts that between April lst, 1902, and March 3rd, 1903, no fewer than 800,100 charges of glycerinated calf lymph were issued. In commenting upon the administrative measures taken to control the prevalence of small-pox the medical officer inferentially criticises the slack administration of certain provincial boards of guardians who, with small-pox at their gates and the public clamouring for facilities to obtain prompt revaccination, refused to open stations whereat such revaccination could be performed not only expeditiously but at a cost to the guardians of half the amount which would have to be paid were such revaccinations performed at the homes of the people. Mr. Power speaks sympatheticallywe might almost say encouragingly-of those sanitary authorities whose districts were inflicted not only with small-pox but also with antagonistic boards of guardians and who at once acted qtltra vires by practically superseding the defaulting guardians. It is, Mr. Power adds, "much to be desired that action in the above sense be legalised and chief responsibility for vaccination administration in the face of small-pox transferred from the guardians to the public health authority." As we have recently pointed out in our columns action on these lines has now been taken in respect of the urban district council in the Dewsbury
satisfactory
union. a
Turning
to the
appendices
of the volume
we
find in
Appendix A a series of valuable reports by the medical inspectors of the Board and these reports are, as a whole, of a decidedly higher academic level than has been the case for some years past. Dr. G. S. Buchanan’s report on epidemic small-pox in the union of Orsett in 1901-02 is an excellent piece of work which should be carefully studied by those whose knowledge of the influence of small-pox hospitals has been derived from certain text-books the authors of which have not, we fear, taken the trouble to master thoroughly the literature of the subject. It is well that writers upon public health should appreciate the fact that the theory of aerial convection does not rest upon certain remarkable occurrences which took place about the Fulham Hospital on one occasion only but that such occurrences recurred again and again in connexion with the operations of that hospital. Moreover, as Dr. Buchanan points out, occurrences of a similar nature, whatever may be their explanation, have since been observed at Sheffield in 1887-88 ; Oldham, 1893 ; Warrington, 1892-93 ; Bradford, 1893; and Glasgow 1900-01. It is regrettable that in text-books in which the subject is discussed references to these later phenomena are sometimes entirely omitted. Dr. H. ’1’imbrell Bulstrode’s report of the remarkable outbreak of enteric fever and other illnesses which followed the mayoral banquets at Winchester and Southampton and which was traced with an altogether exceptional clearness to the oysters derived from the Emsworth oyster ponds, has been already noticed in our columns.3 One of the most interesting features about this outbreak was the very large number of persons who suffered from attacks of gastro-enteritis which came on at varying intervals after the banquets and in such fashion as to suggest that multiple poisons, in addition to the specific infection of enteric fever, were at work. Dr. L. W. Dana Mair contributes a highly interesting and instructive report upon outbreaks of throat illness at Lincoln in 1902 and 1903 which presented some very puzzling but nevertheless suggestive features. The outbreaks were of short duration and the first one, which affected nearly 200 people, more closely approached scarlet fever in its clinical features than any other of the exanthemata. But many of 2 3
THE THE
LANCET, Oct. 29th, 1904, p. 1227. LANCET, July 18th, 1903, p. 172.
the cases were quite anomalous and the general trend of medical opinion was that the disease was not scarlet fever. To us the clinical description of some of the cases savours of typical scarlet fever and we suggest that perhaps too much may have been made of the absence of albuminuria and of any evidences of infectivity in summing up the case. In some years both these factors may be very largely in abeyance. Certainly, however, many of the cases seem to have been absolutely atypical and this fact suggests that not improbably. there may have been two infections at work, the vehicle of infection in both instances having been the same-i.e., the milk-supplies with which the vast majority of the cases in each of the two The bulk of the victims outbreaks was associated. were adults but this incidence upon adults seems to have been largely due to the age distribution of the population which consumed the infected milk. Dr. Klein and Dr. M. H. Gordon were unable in the first outbreak to discover in the fauces of those attacked anything like the streptococcus scarlatinas but they found in three cases an organism resembling the yeast of alcoholic fermentation and this when inoculated into animals led to disease and death. Dr. Klein thinks it not improbable that this yeast may have been responsible for the first of the two outbreaks. Perhaps the best suggestion to account for the outbreak was that offered by Mr. Page, the deputy town clerk of Lincoln, who observed in the autumn of 1901 that the grass in the field which separated the cowsheds of the suspected dairy from the grazing meadows was diseased and it appears that such grass was actually affected with ergot. But what Mr. Page saw was not ergot but some brownish-red algous growth which covered his boots with powder and which was probably what is known as "rust," a diseased condition from which, also, the grass in the adjoining field appears to have suffered. The view that both of these outbreaks may have been due to this fungus receives support from the fact that these outbreaks occurred in the spring and the udders of the cows may have become infected by the animals lying on the grass. But it has to be observed that in the second outbreak, which occurred in the spring of 1903, the symptoms resembled scarlet fever and the outbreak was associated with definite illness among the cows in the implicated dairy. Dr. Klein found that two of the cows presented a vesicular eruption on the udders and teats somewhat similar to that described by him in the case of the historical " Hendon disease."" The value of the bacteriological as contrasted with the chemical examination of water is shown in striking fashion by a report by Dr. Bulstrode on the water-supply of the Bridgend urban district in South Wales. This watersupply was derived from springs in the carboniferous limestone, such limestone being permeated with fissures and with " swallowholes, or " pots" as they are termed The report of the chemist in geological language. had always been favourable to this water which was supplied unfiltered to Bridgend and at first the bacteriologist also spoke not unfavourably of the water.. But soon the bacteriological examination raised suspicion that the water was polluted and owing to the persistence with which the bacteriologist-Dr. W. G. Savage, the present medical officer of health of Colchester-pressed this point the local authority invoked the aid of the Local Government Board. Dr. Bulstrode found that the spring from which the water was derived flowed into an open basin in the rock and that the evidence pointed strongly to the conclusion that this spring was liable to pollution, both through fissures and through "swallow" holes. Moreover, this basin was within a short distance of the sea and on the side of a polluted river. Hence, when the high spring tides forced the polluted water back such water flowed over into the spring basin and polluted its contents. Samples of the spring water were taken and were condemned by the bacteriologist but approved by the chemist. It is satisfactory to find that the inspector’s advice that the water should be carefully filtered was at once adopted by the water company. Dr. S. Monckton Copeman furnishes a very instructive report of an outbreak of casual cow-pox among the cows on a farm near Reigate to which attention was called in the first instance by Mr. E. L. Jacob. The steps by which the malady was conveyed from one farm to another and to the hands of the milkers were very clearly determined and set oub but the attempt to discover whether the disease was traceable directly or indirectly to small-pox in the human
1611
subject was not so successful. Dr. Copeman carried out some period in the 76 large English towns. The rates in the inoculation experiments in connexion with this interesting eight Scotch towns ranged from 11’0 in Leith and 13’7 outbreak and he was able to show conclusively that the in Aberdeen to 20’7 in Dundee and 20 ’ 9 in Greenock. The cow-pox in this instance was true" and not " spurious." 594 deaths in these towns last week included 21 which The question arose as to whether the milk of the cows affected were referred to whooping-cough, 18 to diarrhoea, nine to diphtheria, eight to measles, three to "fever," and one was fit for human consumption but fortunately the accommodating attitude of the farmer rendered it quite unnecessary to scarlet fever. In all, 60 deaths resulted from these to resort to a legal tribunal for the settlement of the principal infectious diseases last week, against 58, 59, and 47 in the three preceding weeks. These 60 deaths difficulty. Dr. R. Bruce Low completes Appendix A by an exhaustive were equal to an annual rate of 1’88 per 1000, which was summary of the progress and diftusion of plague throughout 0-4 per 1000 above the mean rate last week from the the world in 1902 and in our second notice we shall deal with same diseases in the 76 large English towns. The fatal Appendix B which relates to the experimental work carried cases of whooping-cough, which had been 17, 20, and 19 in the three preceding weeks, rose again last week to 21, out under the direction of the Board’s medical department. of which 18 were registered in Glasgow and two in Aberdeen. The deaths from diarrhoea, which had been 27 and 19 in the two preceding weeks, further declined to 18 last week, and VITAL STATISTICS. included 11 in Glasgow and four in Dundee. The fatal cases of diphtheria, which had been eight, three, and two in the three preceding weeks, rose again last week to nine, of HEALTH OF ENGLISH TOWNS. which five occurred in Glasgow and three in Edinburgh. IN 76 of the largest English towns 7596 births and 5075 The fatal cases of measles, which had been nine, eight, deaths were registered during the week ending Nov. 26th. and five in the three preceding weeks, increased again to The annual rate of mortality in these towns, which had last week, and included five in Aberdeen. Of the been 149, 157, and 16 6 1000 in the three preceding eight three deaths from "fever"registered last week two were weeks, farther rose to 17’ 3 per 1000 last week. In London recorded in Glasgow. The deaths attributed to diseases of the death-rate was 16 8 per 1000, while it averaged the respiratory organs in these towns, which had been 17’6 per 1000 in the 75 other large towns. The lowest and 154 in the three preceding weeks, further death-rates in these towns were 9’ 3 in West Bromwich, 119, 136, of the rose last week to 174, and were 26 in excess 10’ 2 in Kings Norton, 11 - 0 in Hastings and in Huddersfield, number in the corresponding period of last year. The 11’33 in Boumemouth, 11’8 in Willesden and in Devonport, causes of 20, or more than 3 per cent., of the deaths 12’ 2 in Blackburn and in York, and 12 ’ 6 in Northampton ; last week were not certified. the highest rates were 21 ’00 in Grimsby, 21’ 6 in Liverpool, registered in these eight towns 22 .4 in Wigan, 22 -8 in Birmingham, 23’0 in St. Helens, 24’in Stockport, and 24-8in South Shields. The HEALTH OF DUBLIN. 5075 deaths in these towns last week included 400 The death-rate in Dublin, which had been 21’ 5, 20’2, which were referred to the principal infectious diseases, and 24’2per 1000 in the three preceding weeks, declined against 425,, 380, and 444 in the three preceding again to 22’ per 1000 during the week ending Nov. 26th. of these resulted from 400 deaths, 120 weeks; measles, During the past four weeks the death-rate has averaged 22’ 1 73 from diphtheria, 68 from diarrhoea, 53 from whoopingthe rates during the same period being 16 0 1000, per 48 from scarlet cough, fever, 36 from "fever" (princi- in London and 16’7 in Edinburgh. The 164 deaths of pally enteric), and two from small-pox. No death from persons belonging to Dublin registered during the week any of these diseases was registered last week in Hastings, under notice showed a decline of 12 from the number in the Brighton, Bournemouth, Southampton, Reading, Handsweek and included 21 which were referred to the worth (Staffs.), West Bromwich, Kings Norton, Warrington, preceding infectious diseases, against 13, 12, and 20 in the principal or Swansea ; while they caused the highest death-rates in three preceding weeks ; of these, 12 resulted from East Ham, Hanley, Grimsby, St. Helens, Salford, Rochdale, four from whooping-cough, four from diarrhoea, measles, West Hartlepool, South Shields, and Rhondda. The greatest and one from scarlet fever, but not any from small-pox, proportional mortality from measles occurred in Grimsby, diphtheria, or "fever." These 21 deaths were equal to an Liverpool, St. Helens, and Tynemouth ; from scarlet fever rate of 2’ 9 per 1000, the death-rates last week from the in Rochdale; from diphtheria in Ipswich, Grimbsy, West annual infectious diseases 0 ’ 8 in London and 0 ’ 6 in principal Hartlepool, and Merthyr Tydfil ; from whooping-cough in" Edinburgh. The deaths frombeing which had been six, measles, Coventry, Huddersfield, and South Shields ; from "fever" seven, and eight in the three preceding weeks, further in Rhondda ; and from diarrhoea in Hanley and Barrowincreased last week to 12. The four fatal cases of whoopingin-Furness. One fatal case of small-pox was registered corresponded with the number in the preceeding last week in Oldham and one in South Shields, but none in cough while the four deaths from diarrhoea showed a slight week, any other of the large towns ; and only one case of small- decline. The 164 deaths in Dublin last week included 28 of pox remained under treatment at the end of the week children under one year of age and 48 of persons aged 60 in the Metropolitan Asylums hospitals. The number of and upwards ; the deaths of infants were slightly scarlet fever patients in these hospitals and in the London years fewer than in the preceding week, but the deaths of elderly Fever Hospital, which had been 2782, 2843, and 2773 on the persons showed an increase. Seven inquest cases and eight three preceding Saturdays, had declined again to 2741 on deaths from violence were registered; and 55, or more than Saturday, Nov. 26th ; 262 new cases were admitted during the a third, of the deaths occurred in public institutions. The week, against 294, 294, and 259 in the three preceding weeks. causes of 8, or nearly 5 per cent., of the deaths registered The deaths in London referred to diseases of the respiratory in Dublin last week were not certified. organs, which had been 285, 324, and 361 in the three preceding weeks, further increased to 385 last week, but
I’
per
17 below the number in the corresponding period of last year. The causes of 70, or 1’44 per cent., of the deaths in the 76 towns last week were not certified either by a registered medical practitioner or by a All the causes of death were duly certified in coroner. were
THE SERVICES. ROYAL NAVY MEDICAL SERVICE.
following appointments are notified :-Fleet SurWest Ham, Bristol, Leicester, Manchester, Bradford, Leeds, : C. S. Woodwright to the Irresistible, on recommissionHull, Newcastle-on-Tyne, and in 46 other smaller towns ;geonsand V. G. Thorpe to the Hercu1es, temporary. while the largest proportions of uncertified deaths were ing, registered in Birmingham, Liverpool, St. Helens, Burnley, ROYAL NAVAL VOLUNTEER RESERVE. Sheffield, Sunderland, South Shields, and Gateshead. The undermentioned gentleman has been appointed a Surgeon :-Thomas Caldwell Litler Jones (dated Nov. 25th, HEALTH OF SCOTCH TOWNS. 1904). The annual rate of mortality in eight of the principal ROYAL ARMY MEDICAL CORPS. Scotch towns, which had been 17-8, 17-5, and 17-3 per Lieutenant MacDonald has left Aldershot for service in 1000 in the three preceding weeks, rose again to 18’0 India. Major H. D. Rowan is held in readiness to embark per 1000 during the week ending Nov. 26th, and was for India for service in the Punjab. Lieutenant-Colonel 0’77 per 1000 in excess of the mean rate during the same E. M. Wilson, C.B., C.M.G., D.S.O., retired-pay, is THE
copies,
edition) have been so](1. The stock remaining in hand of the PharmaIt will, 1128 copies and of the Addendum 2001 copies. probably be necessary to print a fresh issue of the Pharmacopoeia before next November.
is
therefore,
The committee desire, on the retirement of Dr. Payne from the to record their grateful sense of the services which he rendered to the committee, especially in rclatiott to the formation and of its library of reference. arrangement Dr. Norman Moore has, at the request of the committee, undertaken of the library in the place of Dr. Payne. the charge The committee have received with satisfaction the appended communication and inclosures from the Privy Council respecting the proposed agreement on the subject of international uniformity in the pharmacopceial preparations of potent remedies. The successive stages in the negotiations on this subject are set forth in the minutes. That so large a measure of approval should have been accorded to the agreement by the signatory national authorities is a matter of It indicates that the proposals of the International Conference at Brussels have been deemed by the Governments of Europe and America to be both desirable and practicable. The committee will naturally keep in mind the terms of the agreement when they undertake the revision of the Pharmacopoeia of 1898. The committee have been placed in communication with the Secretary of State for the Colonies, and through the Privy Council with the Government of India, on the subject of the drugs and preparations sanctioned for Indian and Colonial use in the Addendum of 1900. A paper of inquiries has been drawn up hearing on the question of the ultimate inclusion of these and other articles in the Imperial Pharmacopeeia, and this paper has, by the courtesy of the Secretaries of State, been brought to the special notice of the various administrative authorities of the Empire. It is confidently expected that the replies to these inquiries will be of the greatest service to the committee at a later stage of their work on the Pharmacopoeia.
Council,
congratulation.
Dr. NORMAN MOORE seconded the motion which
agreed
was
to.
P’inance Committee’s
Report.
Dr. MACALISTER moved that the report of the Finance Committee be received and entered on the minutes as follows :I. The committee had before them the following approximate statements of the estimated receipts and expenditure to the end of the present year, showing at a glance the position of the General and Branch Councils and the Dental Fund :-
-
ùL.VV
The committee drew up the following report :-
It should be remembered that the "estimated contribution" from the branches is a sum fixed by the auclitors and based upon the expenditure of the three previous years. It may be (and this year prob-
ably will be) anticipated.
found that the actual expenditure is not so great as was The English and Scottish branches will not be able to pay their contributions in full out of income. The questions which appear to call for consideration are as
follows
:-
General Council.-There has been received from the builders next door .E1000 for C’oneessiolls made to them and for breach of agreement. This sum cannot rightly be considered income. If the General Council transfer ;;C1000 to the English Branch in reduction of the mortgage the English Branch can then transfer ;;C1000 to the General Council towards the deficit of its "estimated contribution." The result of this will be
I Pharmacopoeia
account and reducing the mortgage by £ 1000, will have small cash balance. Dental Fund.—There should be about .E17CO in hand at the end of the year provided that the English Branch repays its loan. II. The committee also considered a report relating to the provision of a new fireproof safe and the institution of a new system for filing documents in connexion with the Medical Register remitted to them by the Executive Committee at its meeting on Nov. 21st, 1904, under the following resolutions "That this report be remitted to the Finance Committee with the expression of the opinion of the Executive Committee that it is desirable that the suggestions in regard to the introduction of the new system and the provision of a new safe should be adopted and that the committee be requested to consider if there are any means of meeting the expense." RECOMMENDATIONS. I. That the General Council apply the £ 1000 received from the builders towards the reduction of the mortgage to the English Branch Council of the General Council’s property. II. That when the accounts of the Dental Fund for the year are made up, the available surplus standing to the credit of the fund be invested in Consols. III. That the funds to carry out the suggestions in the report be provided by means of a loan from the PharmaeoDceia account, bearing interest at 3 per cent., repayable by equal annual instalments over a period of five years. a
Dr. MCCALL ANDERSOX seconded the motion which
agreed
was
to.
The Council then
adjourned till Monday.
ANNUAL REPORT OF THE MEDICAL OFFICER OF THE LOCAL GOVERNMENT BOARD.1 FIRST NOTICE. No one can carefully study the report for 1902-03, which is that at present before us, without arriving at the conclusion that the traditions of the medical department of the Local Government Board with regard to thoroughly scientific inquiries and reports are being fully maintained under the existing regime. In fact, a study of this report makes us regret two things-firstly, that time does not allow of the production of more documents of an equally exhaustive nature ; and, secondly, that these reports of the medical department do not receive a wider circulation than is at present the case. Unfortunately, in one way, these reports are so thorough and comprehensive and are so well illustrated with plates, maps, and diagrams that the cost, although in no sense prohibitive, is such that the volumes are not likely to find their way to the private libraries of every medical officer of health throughout the country. We are afraid, too, that many of the smaller local authorities in this country will hesitate before providing their medical officers of health with this very necessary literature. Moreover, in a very large number of public health offices there is practically nothing to. which the name of a public health library could be properly applied. We think, however, that every medical officer of health should make application to the local authority for these volumes and that they should become not the private property of the medical officer of health but part of the library which should be found in the office of every sanitary authority. The report proper consists of an introduction addressed by the present medical officer, Mr. W. H. Power, C.B., F.R.S., to the President of the Local Government Board. This introduction, which practically summarises the medical inspectors’ reports which are contained in the volume in the form of an appendix, is admirable and it contains, we fear, as much expression of the personal opinion of Mr. Power as we are likely to get under the present system of administration. We confess, however, that it would be both inspiring and refreshing if we could have the benefit of the medical officer’s views upon questions such as the provision of isolation hospitals, the value of sanatoriums for pulmonary tuberculosis, and other problems concerning which the outside public health service would be glad of the light which Mr. Power could undoubtedly throw upon them were he free to express his views. And now as regards the actual contents of the current volume.
1 Thirty-second Annual Report of the Local Government Board 1902-03. Supplement containing the reportof the medical officer for 1902-03. London : Eyre and Spottiswoode. 1904. Pp. li.-709, with maps and illustrations. Price 8s.3d.
1610 In the matter of vaccination it is encouraging to find that the figures for 1901, which are those here dealt with, show that the improvement which was noticed in 1898 has been almost continuously maintained and that the percentage of children remaining unvaccinated, which in 1898 was 26’6, has. been in succeeding years up to 1901 26’8, 19’9, and 17’3 per cent., and such increase in vaccination has been on the whole general throughout the country. There have been an increase of infantile vaccination in all the 43 counties of England and a decrease during the " same period of conscientious objection" in 50 per cent. of to learn that the such counties. It is also National Glycerinated Calf Lymph Establishment has been equal to the demands which were made upon it during 1902-03 by public vaccinators. Some idea of such demand may be gathered from the facts that between April lst, 1902, and March 3rd, 1903, no fewer than 800,100 charges of glycerinated calf lymph were issued. In commenting upon the administrative measures taken to control the prevalence of small-pox the medical officer inferentially criticises the slack administration of certain provincial boards of guardians who, with small-pox at their gates and the public clamouring for facilities to obtain prompt revaccination, refused to open stations whereat such revaccination could be performed not only expeditiously but at a cost to the guardians of half the amount which would have to be paid were such revaccinations performed at the homes of the people. Mr. Power speaks sympatheticallywe might almost say encouragingly-of those sanitary authorities whose districts were inflicted not only with small-pox but also with antagonistic boards of guardians and who at once acted qtltra vires by practically superseding the defaulting guardians. It is, Mr. Power adds, "much to be desired that action in the above sense be legalised and chief responsibility for vaccination administration in the face of small-pox transferred from the guardians to the public health authority." As we have recently pointed out in our columns action on these lines has now been taken in respect of the urban district council in the Dewsbury
satisfactory
union. a
Turning
to the
appendices
of the volume
we
find in
Appendix A a series of valuable reports by the medical inspectors of the Board and these reports are, as a whole, of a decidedly higher academic level than has been the case for some years past. Dr. G. S. Buchanan’s report on epidemic small-pox in the union of Orsett in 1901-02 is an excellent piece of work which should be carefully studied by those whose knowledge of the influence of small-pox hospitals has been derived from certain text-books the authors of which have not, we fear, taken the trouble to master thoroughly the literature of the subject. It is well that writers upon public health should appreciate the fact that the theory of aerial convection does not rest upon certain remarkable occurrences which took place about the Fulham Hospital on one occasion only but that such occurrences recurred again and again in connexion with the operations of that hospital. Moreover, as Dr. Buchanan points out, occurrences of a similar nature, whatever may be their explanation, have since been observed at Sheffield in 1887-88 ; Oldham, 1893 ; Warrington, 1892-93 ; Bradford, 1893; and Glasgow 1900-01. It is regrettable that in text-books in which the subject is discussed references to these later phenomena are sometimes entirely omitted. Dr. H. ’1’imbrell Bulstrode’s report of the remarkable outbreak of enteric fever and other illnesses which followed the mayoral banquets at Winchester and Southampton and which was traced with an altogether exceptional clearness to the oysters derived from the Emsworth oyster ponds, has been already noticed in our columns.3 One of the most interesting features about this outbreak was the very large number of persons who suffered from attacks of gastro-enteritis which came on at varying intervals after the banquets and in such fashion as to suggest that multiple poisons, in addition to the specific infection of enteric fever, were at work. Dr. L. W. Dana Mair contributes a highly interesting and instructive report upon outbreaks of throat illness at Lincoln in 1902 and 1903 which presented some very puzzling but nevertheless suggestive features. The outbreaks were of short duration and the first one, which affected nearly 200 people, more closely approached scarlet fever in its clinical features than any other of the exanthemata. But many of 2 3
THE THE
LANCET, Oct. 29th, 1904, p. 1227. LANCET, July 18th, 1903, p. 172.
the cases were quite anomalous and the general trend of medical opinion was that the disease was not scarlet fever. To us the clinical description of some of the cases savours of typical scarlet fever and we suggest that perhaps too much may have been made of the absence of albuminuria and of any evidences of infectivity in summing up the case. In some years both these factors may be very largely in abeyance. Certainly, however, many of the cases seem to have been absolutely atypical and this fact suggests that not improbably. there may have been two infections at work, the vehicle of infection in both instances having been the same-i.e., the milk-supplies with which the vast majority of the cases in each of the two The bulk of the victims outbreaks was associated. were adults but this incidence upon adults seems to have been largely due to the age distribution of the population which consumed the infected milk. Dr. Klein and Dr. M. H. Gordon were unable in the first outbreak to discover in the fauces of those attacked anything like the streptococcus scarlatinas but they found in three cases an organism resembling the yeast of alcoholic fermentation and this when inoculated into animals led to disease and death. Dr. Klein thinks it not improbable that this yeast may have been responsible for the first of the two outbreaks. Perhaps the best suggestion to account for the outbreak was that offered by Mr. Page, the deputy town clerk of Lincoln, who observed in the autumn of 1901 that the grass in the field which separated the cowsheds of the suspected dairy from the grazing meadows was diseased and it appears that such grass was actually affected with ergot. But what Mr. Page saw was not ergot but some brownish-red algous growth which covered his boots with powder and which was probably what is known as "rust," a diseased condition from which, also, the grass in the adjoining field appears to have suffered. The view that both of these outbreaks may have been due to this fungus receives support from the fact that these outbreaks occurred in the spring and the udders of the cows may have become infected by the animals lying on the grass. But it has to be observed that in the second outbreak, which occurred in the spring of 1903, the symptoms resembled scarlet fever and the outbreak was associated with definite illness among the cows in the implicated dairy. Dr. Klein found that two of the cows presented a vesicular eruption on the udders and teats somewhat similar to that described by him in the case of the historical " Hendon disease."" The value of the bacteriological as contrasted with the chemical examination of water is shown in striking fashion by a report by Dr. Bulstrode on the water-supply of the Bridgend urban district in South Wales. This watersupply was derived from springs in the carboniferous limestone, such limestone being permeated with fissures and with " swallowholes, or " pots" as they are termed The report of the chemist in geological language. had always been favourable to this water which was supplied unfiltered to Bridgend and at first the bacteriologist also spoke not unfavourably of the water.. But soon the bacteriological examination raised suspicion that the water was polluted and owing to the persistence with which the bacteriologist-Dr. W. G. Savage, the present medical officer of health of Colchester-pressed this point the local authority invoked the aid of the Local Government Board. Dr. Bulstrode found that the spring from which the water was derived flowed into an open basin in the rock and that the evidence pointed strongly to the conclusion that this spring was liable to pollution, both through fissures and through "swallow" holes. Moreover, this basin was within a short distance of the sea and on the side of a polluted river. Hence, when the high spring tides forced the polluted water back such water flowed over into the spring basin and polluted its contents. Samples of the spring water were taken and were condemned by the bacteriologist but approved by the chemist. It is satisfactory to find that the inspector’s advice that the water should be carefully filtered was at once adopted by the water company. Dr. S. Monckton Copeman furnishes a very instructive report of an outbreak of casual cow-pox among the cows on a farm near Reigate to which attention was called in the first instance by Mr. E. L. Jacob. The steps by which the malady was conveyed from one farm to another and to the hands of the milkers were very clearly determined and set oub but the attempt to discover whether the disease was traceable directly or indirectly to small-pox in the human
1611
subject was not so successful. Dr. Copeman carried out some period in the 76 large English towns. The rates in the inoculation experiments in connexion with this interesting eight Scotch towns ranged from 11’0 in Leith and 13’7 outbreak and he was able to show conclusively that the in Aberdeen to 20’7 in Dundee and 20 ’ 9 in Greenock. The cow-pox in this instance was true" and not " spurious." 594 deaths in these towns last week included 21 which The question arose as to whether the milk of the cows affected were referred to whooping-cough, 18 to diarrhoea, nine to diphtheria, eight to measles, three to "fever," and one was fit for human consumption but fortunately the accommodating attitude of the farmer rendered it quite unnecessary to scarlet fever. In all, 60 deaths resulted from these to resort to a legal tribunal for the settlement of the principal infectious diseases last week, against 58, 59, and 47 in the three preceding weeks. These 60 deaths difficulty. Dr. R. Bruce Low completes Appendix A by an exhaustive were equal to an annual rate of 1’88 per 1000, which was summary of the progress and diftusion of plague throughout 0-4 per 1000 above the mean rate last week from the the world in 1902 and in our second notice we shall deal with same diseases in the 76 large English towns. The fatal Appendix B which relates to the experimental work carried cases of whooping-cough, which had been 17, 20, and 19 in the three preceding weeks, rose again last week to 21, out under the direction of the Board’s medical department. of which 18 were registered in Glasgow and two in Aberdeen. The deaths from diarrhoea, which had been 27 and 19 in the two preceding weeks, further declined to 18 last week, and VITAL STATISTICS. included 11 in Glasgow and four in Dundee. The fatal cases of diphtheria, which had been eight, three, and two in the three preceding weeks, rose again last week to nine, of HEALTH OF ENGLISH TOWNS. which five occurred in Glasgow and three in Edinburgh. IN 76 of the largest English towns 7596 births and 5075 The fatal cases of measles, which had been nine, eight, deaths were registered during the week ending Nov. 26th. and five in the three preceding weeks, increased again to The annual rate of mortality in these towns, which had last week, and included five in Aberdeen. Of the been 149, 157, and 16 6 1000 in the three preceding eight three deaths from "fever"registered last week two were weeks, farther rose to 17’ 3 per 1000 last week. In London recorded in Glasgow. The deaths attributed to diseases of the death-rate was 16 8 per 1000, while it averaged the respiratory organs in these towns, which had been 17’6 per 1000 in the 75 other large towns. The lowest and 154 in the three preceding weeks, further death-rates in these towns were 9’ 3 in West Bromwich, 119, 136, of the rose last week to 174, and were 26 in excess 10’ 2 in Kings Norton, 11 - 0 in Hastings and in Huddersfield, number in the corresponding period of last year. The 11’33 in Boumemouth, 11’8 in Willesden and in Devonport, causes of 20, or more than 3 per cent., of the deaths 12’ 2 in Blackburn and in York, and 12 ’ 6 in Northampton ; last week were not certified. the highest rates were 21 ’00 in Grimsby, 21’ 6 in Liverpool, registered in these eight towns 22 .4 in Wigan, 22 -8 in Birmingham, 23’0 in St. Helens, 24’in Stockport, and 24-8in South Shields. The HEALTH OF DUBLIN. 5075 deaths in these towns last week included 400 The death-rate in Dublin, which had been 21’ 5, 20’2, which were referred to the principal infectious diseases, and 24’2per 1000 in the three preceding weeks, declined against 425,, 380, and 444 in the three preceding again to 22’ per 1000 during the week ending Nov. 26th. of these resulted from 400 deaths, 120 weeks; measles, During the past four weeks the death-rate has averaged 22’ 1 73 from diphtheria, 68 from diarrhoea, 53 from whoopingthe rates during the same period being 16 0 1000, per 48 from scarlet cough, fever, 36 from "fever" (princi- in London and 16’7 in Edinburgh. The 164 deaths of pally enteric), and two from small-pox. No death from persons belonging to Dublin registered during the week any of these diseases was registered last week in Hastings, under notice showed a decline of 12 from the number in the Brighton, Bournemouth, Southampton, Reading, Handsweek and included 21 which were referred to the worth (Staffs.), West Bromwich, Kings Norton, Warrington, preceding infectious diseases, against 13, 12, and 20 in the principal or Swansea ; while they caused the highest death-rates in three preceding weeks ; of these, 12 resulted from East Ham, Hanley, Grimsby, St. Helens, Salford, Rochdale, four from whooping-cough, four from diarrhoea, measles, West Hartlepool, South Shields, and Rhondda. The greatest and one from scarlet fever, but not any from small-pox, proportional mortality from measles occurred in Grimsby, diphtheria, or "fever." These 21 deaths were equal to an Liverpool, St. Helens, and Tynemouth ; from scarlet fever rate of 2’ 9 per 1000, the death-rates last week from the in Rochdale; from diphtheria in Ipswich, Grimbsy, West annual infectious diseases 0 ’ 8 in London and 0 ’ 6 in principal Hartlepool, and Merthyr Tydfil ; from whooping-cough in" Edinburgh. The deaths frombeing which had been six, measles, Coventry, Huddersfield, and South Shields ; from "fever" seven, and eight in the three preceding weeks, further in Rhondda ; and from diarrhoea in Hanley and Barrowincreased last week to 12. The four fatal cases of whoopingin-Furness. One fatal case of small-pox was registered corresponded with the number in the preceeding last week in Oldham and one in South Shields, but none in cough while the four deaths from diarrhoea showed a slight week, any other of the large towns ; and only one case of small- decline. The 164 deaths in Dublin last week included 28 of pox remained under treatment at the end of the week children under one year of age and 48 of persons aged 60 in the Metropolitan Asylums hospitals. The number of and upwards ; the deaths of infants were slightly scarlet fever patients in these hospitals and in the London years fewer than in the preceding week, but the deaths of elderly Fever Hospital, which had been 2782, 2843, and 2773 on the persons showed an increase. Seven inquest cases and eight three preceding Saturdays, had declined again to 2741 on deaths from violence were registered; and 55, or more than Saturday, Nov. 26th ; 262 new cases were admitted during the a third, of the deaths occurred in public institutions. The week, against 294, 294, and 259 in the three preceding weeks. causes of 8, or nearly 5 per cent., of the deaths registered The deaths in London referred to diseases of the respiratory in Dublin last week were not certified. organs, which had been 285, 324, and 361 in the three preceding weeks, further increased to 385 last week, but
I’
per
17 below the number in the corresponding period of last year. The causes of 70, or 1’44 per cent., of the deaths in the 76 towns last week were not certified either by a registered medical practitioner or by a All the causes of death were duly certified in coroner. were
THE SERVICES. ROYAL NAVY MEDICAL SERVICE.
following appointments are notified :-Fleet SurWest Ham, Bristol, Leicester, Manchester, Bradford, Leeds, : C. S. Woodwright to the Irresistible, on recommissionHull, Newcastle-on-Tyne, and in 46 other smaller towns ;geonsand V. G. Thorpe to the Hercu1es, temporary. while the largest proportions of uncertified deaths were ing, registered in Birmingham, Liverpool, St. Helens, Burnley, ROYAL NAVAL VOLUNTEER RESERVE. Sheffield, Sunderland, South Shields, and Gateshead. The undermentioned gentleman has been appointed a Surgeon :-Thomas Caldwell Litler Jones (dated Nov. 25th, HEALTH OF SCOTCH TOWNS. 1904). The annual rate of mortality in eight of the principal ROYAL ARMY MEDICAL CORPS. Scotch towns, which had been 17-8, 17-5, and 17-3 per Lieutenant MacDonald has left Aldershot for service in 1000 in the three preceding weeks, rose again to 18’0 India. Major H. D. Rowan is held in readiness to embark per 1000 during the week ending Nov. 26th, and was for India for service in the Punjab. Lieutenant-Colonel 0’77 per 1000 in excess of the mean rate during the same E. M. Wilson, C.B., C.M.G., D.S.O., retired-pay, is THE