HOSPITAL REFORM.

735 area there is no closet whatever and excrement is thrown round about on the surface of the. ground. Close to this cottage is a pool of stagnant waterinto which heavy rains wash the excrement referred to and from which in times of storm there runs a rivulet which enters the stream passing, and at times partly supplying, the Boswyn tank. The rest of the story is simplicity itself. In October and November three cases of enteric fever occurred at the cottage on the pool;the excrement was deposited round about, was washed into the pool, and so eventually into the Boswyn tank. In Camborne and Illogan enteric fever-obviously waterborne-soon appeared; the stream water was intercepted, the Boswyn tank disused, and the fever ceased. Now the " water company is taking steps to prevent any further pollution of their service." Into the outbreak of enteric fever at Camborne Dr. Bruce Low has recently inquired ’° Have you gone into the question of the Fever and we shall doubtless soon have the pleasure of noticing (Q. 9729.) " Hospital ? (A.) " I daresay it would be instructive, but as one of his masterly reports with which we are now so I say, the subject would be so tremendously vast, and the familiar; we trust, too, that his report will contain a map of time required to hunt up evidence would be so enormous, the district concerned. But how many other water comthat unless one lived in London one could not do it ; and I have gathering grounds, springs, reservoirs, and other panies live 120 miles away." like unto this ? devices (Q. 9730.) " Bat you have made your reputation by thoroughly sifting evidence before you came to a conclusion ?(A.)" Some kind of evidence." MEDICAL CORONERS.

this catohment

asked to be allowed a second interview in order to correct and amplify some of his statements. His final leave-taking of the Commission may therefore be regarded as his ripened judgment and the acme of his knowledge upon all points relating to vaccination. It is generally accepted that the evidence with regard to smallpox and vaccination as illustrated in our small-pox hospitals is at least of some value, but Mr. Wallace seems to think such a study, to say the least of it, inconvenient. Here is a question put to Mr. Wallace by the Chairman on the occasion of his first examination ; (Q. 7069.) " Have you examined the statistics with regard " to the Metropolitan Asylum Board’s hospitals ? (A.) "II have not paid much attention to them." Similarly upon his second visit to the Commission, when he returned especially to supplement his evidence he was asked by Sir William Savoryso many errors that he

___

Does this

mean

evidence

as

that it is Mr. Wallace’s custom to omit such tells against any thesis he may be interested in developing? All Mr. Wallace’s evidence may be found in the third report of the Commission and we commend it to our readers. They will then understand why Mr. Wallace speaks of the report as a "feeble report," and why vaccination "never saved a single life." It is narrated in Sir John Simon’s " Papers Relating to the History and Practice of Vaccinationthat a certain Prince Kaunitz forbade two words to be uttered in his presence: the one was smallpox" and the other "death." We expect Mr. Wallace’s best friends omit all reference to Dr. McVail or to the Royal Commission on Vaccination when in the presence of this distinguished expert on inductive and deductive methods.

’, AN election is about to be held for the office of coroner to the Stockton Ward of Stockton-on-Tees. Among

WATER-BORNE ENTERIC FEVER AT ILLOGAN. DR. A. E. PERMEWAN, the medical officer of health of the Redruth rural district, has recently issued a concise report upon an outbreak of enteric fever at Illogan, and the condition of affairs revealed is such as to make us ask why these things have been allowed to continue until an epidemic brought them into public notice. The infected water was supplied by the Camborne Water Company, who have, it appears, two sources of supply-one at Curgenwyn and the other at Boswyn-while a common main conveys the water to Illogan and to Camborne, at which latter place there was a severe outbreak of enteric fever simultaneously with that at Illogan. The Curgenwyn water isi collected into three storage reservoirs which are fed from a spring in the hill above. Reservoirs Nos. 2 and 3 are, we are told, properly protected against pollution, but No. 1 reservoir, which is the lowest and through which the water from Nos. 2 and 3 has to pass before it reaches the main, is apparently liable to be specifically polluted at any moment by means of the drainage from CurgenwynL entering the leat which conveys the water from the! spring to the reservoir. How long this evil has been seen we are not told. The state of affairs at the: Boswyn source of supply was, unfortunately, no better. Here water is stored in an open cemented tank fed bJ means of a pipe from some deep springs near. By the side of the tank there runs a stream which carries off the surface water from the watershed, and which water was,, as occasion required, turned into the tank by means ofxt arranged for the purpose. At one of the cottages iri ,

.

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,

the candidates is Mr. W. J. Beatty, L.R C.P. Edin., &c. Another candidate is a lawyer. There can be, of course, no question as to which of these two gentlemen is A coroner the more suitable candidate for the office. should always be a medical man. Not only is it his duty to hold an inquest into the cause of death-a. function essentially medical-but it also rests with him to decide whether a death is natural or unnatural, whether the cause of a sudden death is known or unknown, and whether a death has or has not been a violent one. Again,. in the matter of viewing the body the coroner, if a medical man, may gain some valuable information from the mere appearances which the corpse presents-appearances which would be a sealed book to any but a medical man. A useless inquest is not only a travesty of law, but it inflicts unnecessary pain upon the relatives of the deceased and’ trouble upon the jurors which might well be spared. or all these reasons it is most desirable that the very responsible office of coroner should be held by a medical man and we most sincerely hope that the electors of the Stockton Ward will think so too. _

HOSPITAL

REFORM.

THE Bradford and District Medico -Ethical Society, a.. body which has done excellent work for the medical profession in fighting the Bradford School Board on the certificate question and in many other ways, has been moved by the recent occurrence of the annual meetings of subscribers to medical charities to make a pronouncement upon the question of hospital abuse. In a letter to the local press. the society points out what cannot be too often pointed out, that nearly all hospitals give as reason for support the fact that the number of patients seeking relief increases year by; year. This is a false argument, for "the largeness of the crowd in the hospitals is no indication whatever of the, value of the work done by them." This, of course, is perfectly true, but the difficulty is to get the public to An increase in the number of patients of a. see it.

thousand or so a year and a certain amount of debt. are the means by which an ordinary hospital livesthe debt especially is an excellent lever for extracting guineas from the charitable. And yet the Bradford society says the present incomes of the Bradford charities are

736 i

sufficient and even superabundant if only the suitable and ereally poor cases were treated. The society goes on to refer to the harm done by the penny-a-week system of subscriptions ; from being a purely voluntary subscription this .penny has come to be in many cases a compulsory one and is looked upon as giving to him who pays it an absolute right to treatment for any ailment, however trivial, and also the right to attend for any length of time. The Bradford esociety concludes by imploring the public to consider these matters. We only hope it will, and that not only in Bradford, for the reform of hospital abuse rests with the public The Hospital Reform Assomore than with anybody else. ciation has, we are glad to see, addressed a memorial to the Governors of the Cardiff Infirmary, whose annual meeting was held on Feb. 28th. This address lays stress upon the .same points as those dealt with by the Bradford society and was, we trust, not without its due effect upon the minds
THE NOTIFICATION OF MEASLES AT BLACKPOOL. SiNCE as far back as the year 1879 measles has been motifiable in Blackpool and an epidemic of this disease -during 1897 has led Dr. Jasper Anderson, the medical officer of health of the district, to compile an interesting report, which he has recently presented to his sanitary authority. It may be noted that Blackpool at the census of 1891 had a population of 23,846 and since that date it has materially increased. From 1880 the notifications of measles have been as

under :-

14’6 per cent., in the second year 11 per cent., in the third year 4’3 per cent., in the fourth year 1’2 per cent., and in the fifth, be it noted, 3-3 per cent. Above this age there was but one death and that in a pregnant woman, aged thirty years, who was confined on the fourth day of the disease. It is an interesting fact that the child was born with the eruption of measles and died when thirty hours old. When a case of measles is notified in Blackpool the measures taken are nearly identical with those practised in con. nexion with scarlet fever-i.e., the infected house is visited and isolation enjoined, and notices are sent to the schools if necessary, to the public library, and to the laundry involved. Memoranda are forwarded to the head of the house setting forth the penalties for the exposure of infected persons or things, and the precautions necessary to be taken when (a) the patient remains at home, and (b) the patient is removed to hospital. The school attendance officer is furnished with, and supplies, any necessary in. formation, and when a fortnight from the onset of the rash has elapsed an inspector calls to ascertain if dis. infection can be carried out. From among the 732 cases which occurred 64 were removed to hospital, there being out of these 64 patients but one death. In the invaded houses there were 833 children under fourteen years of age who were exposed to infection, and of this number 351 had previously suffered from the disease. Of the 482 children who had not before had measles 179 contracted the disease, while of the 351 who had previously been attacked only 17 became affected. Dr. Anderson considers that the methods of prevention adopted led to good results inasmuch as of the 482 children presumably susceptible to measles only 179 contracted the disease, or, as he expresses it, 303 children were prevented from developing measles. Perhaps, however, it would be more correct to say that the 303 children were shielded from the continued exposure to infection. The evidence that the fatality-rate of the disease was diminished by the efforts of the sanitary authority is very strong, as it appears that in the neighbouring town of Fleetwood with a population in 1891 of 9274, which was invaded simultaneously with Blackpool, there were during the second quarter of 1897 30 deaths from measles, whereas in Blackpool there were but 19 deaths. In Fleetwood there is no compulsory notification of this disease. THE EFFECT OF STETHOSCOPIC PRESSURE IN PHYSICAL EXAMINATION. IN the New York Medical Journal, Dec. 4th, 1897, Dr. Henry Sewall has called attention to the modifying effects on the sounds heard in the use of the binaural and its value in the physical examination of the heart. It is strange that some of Dr. Sewall’s observations with regard to an instrument in such constant and universal use have not been anticipated. The sounds heard in auscultation are made up of two elements-those emitted by the body which originates the vibrations and those which arise from resonance. If a watch be suspended in a small box from one of its sides and a binaural stethoscope passed lightly over the outer surface of that side the watch will be heard loudly everywhere, but if the bell is applied with increasing pressure the sound gradually dies out and usually fails except opposite the area of contact with the watch. Bat with the straight wooden stethoscope the effect of pressure is rather to increase the sound. The explanation of the difference is that sound is conducted by the stethoscope itself in the case of the wooden instrument and by the contained air in the binaural instrument. Pressure on the former has only the effect of increasing the contact of the rim, on the latter it damps the vibrations of the surface included by the border of

of pressure

It is, however, necessary to bear in mind in studying these figures that since 1891 more care has been taken by means of house-to-house inspection to discover cases - of the disease in question. The epidemic of 1897 began, it seems, with imported cases, Blackpool as a resort of ,pleasure for a large and scattered population being especially liable to these introductions of disease from "without. Measles when introduced soon spread and in the week ending April 17th no less than sixty-six cases were motified. On April 21st all the public elementary schools with one exception were closed, and a fortnight after this the week’s notification fell to thirty-six, the numbers continuing to decrease until a localised outbreak caused a further rise. Dr. Anderson furnishes evidence to show that the scholars of different schools became infected - one after another and the fact that "explosions" of the disease occurred in connexion with the scholars from particular schools supports a thesis that infection was .actually contracted at school. The fatality-rate of those attacked during the first year of life was no less than

stethoscope