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Incorporated Society of Medical Officers of Health, West of England and South Wales Branch
5°
PROCEEDINGS
O F TI-tE W. O F E N G L A N D A N D S. W A L E S B R A N C H .
lenient towards antivaccinators, antisewerists, and antisanitarians, of all sorts and denominations, but I believe fully in the Nemesis which most surely overtakes everyone who breaks the sanitary code of nature, and I am sure that like many of the unpleasant and even venomous members of the animal kingdom, the faddists have their uses. What an unbearable set of people we should be if we had no opposition ! Perhaps even a worse fate might overtake us, and, tempted by theory into the garden of the Fairy Experiment, we might become engulfed in the vast chasm of imperfectly ascertained processes. It is, if I recollect rightly, Dr. Oliver Wendell Holmes who, in his " Autocrat of the Breakfast Table," describes every man as of a triple n a t u r e - the man as others see him, as he thinks himself to be, and as he really is. Perhaps I have tried to paint the Medical Officer as I think he ought to be. I am sure that in all work it is good to have an ideal, however difficult it may be to depict one. But if I cannot portray an ideal Medical Officer, I may permit myself a quotation upon Local Sanitary Administration as it should be : - - " Our Public Health Acts are but a mighty system of coercion designed chiefly to purge the body politic o f physical dirt and disorder, and the irremovable curses they entail. Urban and Rural Sanitary Authorities are the masters of the forces of life and death in one great section, and mete them out to poor sinners in their voyage through this world as _,~Eolus meted out the blasts he guarded, but with their caprice tempered by law. Each member of a Local Board is a trustee of the Public Health, and as he and his brethren discharge their vital functions they bring down upon the district the ~eward or the vengeance of that just and unerring nature which always pays in kind." " W i s e ratepayers will elect wise boards, and good boards will appoint good officials." To us is thus committed a great and important trust. Let us see that we are worthy of it, even in our hour of trial and opposition. One more word, more to the world at large than to our own limited audience. The Sanitary future of our country has already been shown to depend mainly upon the efficiency of the units who in their aggregate form the local bodies which govern us. From Local Boards and Town Councils to County Councils and Parish Councils the tendency is, day by day, more and more to place the Sanitary destinies ~f the Country in the hands of those least fitted to control them. The lesson which these men have to learn, and which it is our glorious but scantily remunerated lot to teach, is admirably set forth in the words of the anonymous writer from whom I have already quoted : "At this moment, judging by the unerring standard of the death rate, England stands at the head of civilization far above the shabby pretenders who conceal dirt below the glitter of finery. For what
is more barbarous than for a nation to sit with arms folded and see a large percentage of its people cut off prematurely by the most infamous of all diseases, those engendered by their own violation of the laws of nature in the item of personal cleanliness. Evety art, every science, every grace of civilization must give the place o f honour to the art, the science and the grace of a cleanly life, fulfilling its natural span unstinted by malaria and zymotics. E n g l a n d with all her faults is facile princeps in the sanitary race. So must she flourish ! " As I cannot expect agreement from everybody with my views, and as a presidential address admits of no debate, I will bid you good-bye in the words of Horace : Farewell : if you c a n m e n d these p r e c e p t s , d o : If not, w h a t serves for me m a y serve for y o u .
Conbtg'lon. At the conclusion of the address the president presented a report from the council of the branch dealing with the necessity for fixity of tenure for medical officers of health. Dr. Boobbyer moved, and Dr. Tew seconded, the following resolution: " That it is no longer desirable in the interest of the public health that medical officers of health be appointed for limited periods, and that every effort be made to obtain an amendment of the law in this particular. " That copies of this resolution be sent to the London Council, and to every branch of t h e Society." The resolution was supported by Drs. May and Barwise, and carried unanimously. The following new Fellow was proposed : John Biggam, M.D. Edin., M.O.H. Sedgley. The members subsequently dined together at the Grand Hotel. INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH,WEST OF ENGLAND AND SOUTH WALES BRANCH. ANNUAL MEETING, THURSDAY~ I I T H OCTOBERj I894.
ON the above date the Annual Meeting of the branch was held in the board room of the Royal Mineral Water Hospital, Bath. P r e s e n t : - - D r s . D. S. Davies,Walford, "Dowson, Blaxall, Alford, Brabazon, Harper, Stockwell, and Heaven, and Mr. J. Wallis Stoddart. A letter from the Secretary of the parent society was read, asking that the subject of " M e d i c a l Practice by Unqualified Practitioners in its Relation to Public H e a l t h " should be considered by the branch and the result communicated. The Secretary called attention to a previous resolution of the branch on the same subject, and after some discusssion the following resolution was proposed by Dr. Brabazon~ seconded by Dr. Dowson, and carried, viz. : " T h a t this branch is of opinion that it would be advantageous to the interests of the public health if Parliament would take steps to prevent the evil
PRESIDENTIAL consequences arising from unqualified practice, and that the matter should be taken in hand by the Parliamentary Bills Committee of the British Medical Association." The Secretary was desired to send a copy of the resolution to the Secretary of the Parliamentary Bills Committee of the British Medical Association. A second letter from the Secretary of the parent society with reference to the nomination of Fellows and officers to serve on the Society's Council was received between the branch meetings, and could not be considered till it was too late to make any nominations. It was decided that it should be an instruction to the Secretary to ask for any nominations at the future July meetings of the branch. The Treasurer's account was next presented and audited, and his report read. The report stated that the branch expenses had been very s m a l l - ..~ I i s. i o d . - - t h e receipts had amounted to ~ 3 17 s. and that the year 1894- 5 was commenced with a balance of ,~5 9 s. 2{d., as against a balance of ,~--,C2i4s. o½d., at the beginning of I893- 4 . A large number of subscriptions was still outstanding, five being for the year 1892-3, and no less than 39 being those for the year just closed, making a total of 44 subscriptions amounting to ..~7 I4S., due to the branch for past years. It was hoped that the members would be satisfied with the balance in hand, and with the financial soundness of the branch. The account and report were accepted. T h e Secretary then presented his report, which was to the following effect : - " D u r i n g the past year the new members joining the branch have b e e n : Fellows 4, Members i, Associates i ; total, 6. The branch therefore consists of Fellows 4 ° , Members 3, Associates 7, Honorary Associates 4, making a total membership of 54- T h e branch will, I am sure, greatly regret the loss through death of one of its Fellows, Dr. George Wilson, Medical Officer of Health for Clutton, who was a regular attendant at the meetings till failing health forbade. There have been the usual three ordinary meetings, two being held at Bristol and one at Cardiff. Among the papers read at these meetings were one by Dr. Walford ( ' N o t e s on an Outbreak of Typhus F e v e r ' ) , one by Dr. Walter Dowson ( ' S o m e Points in the Natural History of Small-pox'), and one by M r . J. Wallis Stoddart ( ' W h a t is a Dangerous Potable Water'). These have all appeared in the Society's journal. Reports of branch proceedings have from time to time appeared in PUBLIC HEALTH. T h e branch has also made a representation to the Council of the parent society with respect to an alteration in the Articles of Association under the head ' M e m b e r s h i p , ' submitting that it is desirable to substitute for the words 'ordinary members who shall be medical men qualified for appointment as Medical Officers of H e a l t h ' the words 'ordinar'¢ members who shall be medical men holding a degree or diploma
ADDRESS.
51
in public health.' In my capacity as Secretary--to express the views of the b r a n c h - - I attended a meeting, in London, of a Sub-Committee appointed by the Council to consider certain matters with regard to the representation on the Council of unattached members, the reference of certain matters to the branches before action by the Council, the inclusion in the Fellowship of Army, Navy, and Colonial medical officers doing work of a similar nature to that of Medical Officers of Health, and the question of the payment of representatives attending Council meetings in London. The decision of the Council on the Sub-Committee's recommendations has appeared in the Journal. Numerous other matters of more or less. import have from time to time been considered, and resolutions passed thereon. I think it will be generally admitted that the branch has fulfilled its purposes by bringing forward interesting matters for discussion, and permitting free interchange of opinions between medical officers, who would otherwise, owing to distance from each other, fail to keep in touch." The report was accepted. The retiring Council then nominated the O ~ c e r s and Council for 1894-95 and the names were approved by the meeting as follows: OFFICERS. P r e s i d e n t - - D r . D. S. Davies, Bristol. President-elect--Dr. H. J. Alford, Taunton. Vice-President--Dr. E. Davies, Swansea. Hon. Treasurer and Secretary--Dr. John C. Heaven, Clifton.
COUNCIL. Dr. Bond, Gloucester ; Dr. Brabazon, Bath ; Dr. Harper, Batheaston ; Dr. Prichard, Cardiff; Dr. Partridge, Stroud. Dr. Walter Dowson, already a member of the branch, having become eligible for the Fellowship as an acting Medical Officer of Health, was proposed as a Fellow by Dr. D. S. Davies, seconded by Dr. Brabazon, and elected. PRESIDENTIAL ADDRESS. The President (Dr. D. S. Davies) upon taking the chair firstthanked the members of the branch for the honour conferred upon him in electing him to the post, and trusted the deliberations of the coming year would he no less pleasurable and profitable than those of the past session. H e then proceeded to touch on several points of interest to all engaged in practical health work. Tracing the growth of public interest in sanitary work, he showed how the initial difficulty of enforcing ideas of cleanliness in the public mind having been overcome, it was followed by a reaction of crudely specialised interest, resulting in the predominant popular notion that all sanitary, or as he preferred to call it public health work, was bound by the limitation of drains, or " s o m e t h i n g to do
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W. O F E N G L A N D
with drains " ; a limitation interfering seriously with t h e progress of research and scientific study of disease. T h e helpful stimulus of public opinion was recognised, though the attitude of reproach for non-attainment of a high ideal, together with a lack o f sympathy for past endeavour, and of recognition o f secured improvement, too frequently assumed by self-constituted philanthropic bodies confing late into the field of work, was deplored as dispiriting and often actually obstructive to steady progress. Criticising the control of infectious disease by notification, the speaker feared it was in many cases far too perfunctory, and possibly this contributed in s o m e degree to the slipshod notions entertained by the public. T h e leaving of " s o m e disinfectants" at a cottage in answer to a scarlet fever notification could neither act preventively nor tend to enlighten public opinion. But are the officers to blame for not securing isolation with nowhither to remove cases ? O n the question of hospital accommodation, which should be sufficient in a m o u n t and quality for all districts, the speaker critisised the d e p e n d e n c e upon large urban centres of the fringing local boards and rural districts except under conditions of proved expediency and under equitable adjustment of expenses, and strongly advocated the unification 9 f county administrative work under the advice o f skilled county medical officers of health, whereby " i s o ] a t i o n , " with its full connotation of disinfection, quarantine observation, school control, and internotification between districts, would be uniformly secured. T h e need of and the importance of inter-notification from district to district was insisted upon, and its observed value during t h e ~893- 4 small.pox outbreak set forth. T h e collect i o n and distribution o f the notification returns by the Local G o v e r n m e n t Board showed the State's appreciation of the importance of the system o f inter-notification, which was also largely e m b o d i e d in the English regulations for dealing with shipborne cholera. T h e speaker expressed a guarded opinion as to the advantage likely to accrue to the p u b l i c health service from the establishment o f Parish Councils, and deprecated any lowering o f the qualification for service upon District Councils. It requires an education of some width to grasp the necessity of spending m o n e y for future and as yet hardly apparent benefits, and the work of those responsible for public health must go beyond the hand-to-mouth methods of labour representatives. T h e control of the County Council must in the end be relied upon to conduct, under skilled medical advice, the labours o f Parish and District Councils to useful ends. Dealing with the subject of pensions to municipal officers, the President trusted a workable scheme would soon be forthcoming by which these trusted and useful servants of the public might benefit in th~ evening of their life.
A N D S. W A L E S B R A N C H .
A vote of thanks to the President for his address was p r o p o s e d by Dr. Brabazon, s e c o n d e d by Dr. Alford, and carried unanimously. WHAT
IS
A DANGEROUS POTABLE WATER ?
T h e discussion on Mr. Stoddart's paper, " W h a t is a Dangerous Potable W a t e r ? " followed : m Dr. Heaven stated that he agreed generally with Mr. Stoddart's criticisms on the report of the Royal Commission on the Metropolitan Water Supply, as he failed to see that all their conclusions were justified by the evidence. He called attention to some ot the important points in the paper, and especially took exception to the idea ot the Commissioners Ibat dilution of infective matter ensured safety. He was of opinion that neither chemical analysis nor inspection of surroundings should be in itself relied on as showing the the probable safety or not of a water, but that both means should always be employed. Dr. Alford agreed with the criticism on the Commissioners. He regarded chemical analysis as the best test of safety~ but expressed strongly the opinion that it ]s important to know the surrounding conditions before giving an opinion on any sample. He endorsed Mr. Stoddart's views as expressed in the paper, and accepted his definition of a potable water. Dr. Blaxall was of opinion that in judging of the safety of any water it is absolutely necessary to consider the nature of the gathering ground, for if that were polluted it would sooner or later cause disease. He considered analysis a valuable test, but it would not always decide on safety or danger of a water. He was of opinion that dilution cannot be relied upon to obviate danger, and that this view could not be too strongly impressed on all concerned. Dr. Walford said he agreed generally with Mr. Stoddart's conclusions, but could not quite agree with his view as to sand filtration--be had understood that Altona escaped cholera on account of the water being filtered, and suffered when filtration broke dowm Efficient filtration appeared to him to be a safeguard. Drs. Brabazon and Dowson also took part in the discussion. Mr. Stoddart, in reply, after referring to the favourable reception accorded to the paper, remarked that the only po!nt upon which there appeared to be any real difference of opinion, was the relative usefulness of the means available for determining the character of a water. Whilst admitting without reserve that every circumstance that can throw light upon the possible pollution of a supply should be taken into consideration ; still it was necessary to recogalse that comparatively few sources of water are, or can be, absolutely beyond reach of all contamination, especially in the case of private houses, and the speaker still adhered to the opinion that of all means at our disposal of ascertaining whether a given well water was affected by insanitary surroundings, none approached an intelligent consideratio*~ of analytical details. To this end a knowledge of the normal water of the locality was a great assistance, if not an essential ; wherein lay the advantage of the local analyst, and Mr. Stoddart deplored, with Dr. Alford, the tendency of interested persons to withhold information as to the source of samples, and even to furnish details that were known to be incorrect. Further, it was perfectIy obvious that the value of analysis was largely dependent upon its proper application, that the examination should be repeated sufficiently often to cover such alterations as must result from time to time from increase of pollution, etc., and especially that all.public water supplies should be kept under constant superwslon. With reference to the observation recorded in the paper (page 365, col. 2) the speaker was glad of the opportunity of pomuag out an omission which materially obscures the significanee of the experiment. Paragraph 7 should conclude, " and . . A at. Ioo c. . both received, etc. " T he objec ' t after stenhsmg of the experiment was of course to contrast the behaviour of the typhoid bacillus in sterilised and unsterilised water
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respectively ; and the earlier disappearance of the bacilli from the latter was attributed to the more tenacious character of the deposit of organisms owing to the presence of water bacteria and not to any destruction of them by antagonistic forms. With reference to the suggestion by Dr. Walford that the speaker under-estimated the value of sand filtration, it was pointed out that the very instance so largely relied upon as evidence of the protection afforded by the process, viz., the difference in incidence of cholera in Hamburg and Altona, furnished also a proof of the danger lurking in the occasional derangement, probably inevitable in filters on so large a scale. The mention, by Dr. Dowson, of the possibility of mistaking other products of human activity for sewage in a water, suggested many points of considerable theoretical interest, but scarcely affected the main issue, i.e., the character of the water as a potable supply. After a vote of thanks to Mr. Stoddart the meeting terminated. PROCEEDINGS OF THE NORTH-WESTERN BRANCH OF THE SOCIETY OF MEDICAL OFFICERS OF HEALTH. THE ordinary monthly meeting of this Branch was held in the rooms of the Chemical Society, Manchester, on Friday, October i2th, at 4 p.m. T h e following members were present: Drs. Anderson (President), Adams, Armitage, Deans, Edlin, Graham, Hannah, Jordan, Kenyon, Niven, Paget, Park, Porter, Sergeant, Stepheuson, Wheatley, and Vacher. The minutes of the last meeting were read and confirmed. Dr. Anderson proposed, and Dr. Vacher seconded, a vote of thanks to Dr. Niven for the trouble he had taken in showing the members of the Branch over the model artizans' dwellings in Oldham Road. A letter was read from the Hon. Secs. of the Central Society, on the question o f unqualified practice. T h e Branch having previously discussed this matter, simply confirmed the resolution passed at the July meeting. A letter was read from the Chairman of the Lytham Ratepayers' Association in answer to an enquiry as to what had been done with regard to the appointment of a Medical Officer of Health for Lytham. A letter was also read from Dr. Eason thanking the Branch for the interest they had taken in this matter. Dr. F. Booth, M . O . H . for St. Ann's-on-Sea: Dr. A. F. Keyworth, M.O.H. for Marple; and Dr. H. P. Smeeth, M . O . H . for Brinnington, who were nominated at the last meeting, were duly elected members. T h e following nominations were r e a d : W. Hodgson, L.R.C.P., L.F.P.F.G., proposed by Dr. Sergeant and seconded by Dr. P a g e t ; M r . T. de Courcy Meade, proposed by Dr. Porter and seconded by Dr. Niven. T h e President then introduced the subject of the relation of this Branch to the Central Society with special reference to the alteration i n paymen, of subscriptions which had been made. After some discussion, the following resolution was proposed by Dr. Paget, seconded by Dr. Niven, and carried : " T h a t this Branch emphatically protests
NORTH-WESTERN
BRANCH.
53
against the arrangement having been made with. regard to the annual subscriptions without t h e Branch having been consulted, and desires to know if the regular liabilities of the Branch will always be discharged by the Central Society." ~cTEST FOR NITRITES AND NITRATES IN POTABLE ~,VATER. '~ Dr. Kenyon demonstrated the test for nitrates and nitrites in potable waters, described by Mr. George Harrows in the " J o u r n a l " o f the Chemical Society, for t 8 9 i , page 32o, with which should be read a paragraph in one of the volumes for r892 , page 657. T h e reagent can be kept, without any trouble, for months unimpaired, and its delicacy is such that it can be used for quantitative deferral. nations, and will easily show "02 parts of nitrogen, in ioo,ooo parts of water. T h e formula is : naphthal. amine, one gramme ; sulphanilic acid, one gramme; ordinary strong hydrochloric acid, 25 cubic centimetres ; boil with 20o c.c. of distilled water until dissolved, adding animal charcoal to decolourise if necessary, fill up to 500 c.c. Ten c.c. of this solution. is added to 50 c.e. of the water to be examined in a small beaker. A very small amount of zinc dust 0"007 gr. is added, the liberated hydrogen reduces nitrates to nitrites, and a crimson colour is pro~, duced. If nitrites are present the colour appears at once, without adding zinc; heat should be applied after twenty minutes or so, and the contents of the beaker brought to the boiling point to get the full tint, which is otherwise partly lost through precipitation by earthy salts present. For t h e purpose of comparison, a standard solution is m a d e by dissolving "72I gramme of nitrate of potash in a litre of water, equal to o ' i part of nitrogen in i,ooo. This is diluted with water to equal i ' o , o'i, o'o~ parts per roo,ooo as required. Dr. Graham then read a paper on " S m a l l Pox Problems."
SIvIALL-POX PROBLEMS. By WILLIAM GRAHAM, M.D., M.O.H. Middle,on. During nineteen years' experience of Middleton~ and its neighbourhood as a general medical practitioner, I have found until recent!y small-pox a very rare disease. I n 188i, shortly after I became Medical Officer of Health for the district, a few cases occurred, but it did not spread to any extent, and no case was notified from incorporation of the borough in 1886, until the 3rd November, 1892 , although a compulsory order was in force from August, I889. The first patient received the contagion, almost beyond a doubt, from the vicinity of Westhulme Hospital, Oldham. She was treated at home, but great precautions were taken to prevent a spread, although a child, aged three years, to whom this patient was aunt, became affected, and was removed to Westhulme Hospital, in the vicinity of which the child had resided with the parents.
PROCEEDINGS
O F TI-tE W. O F E N G L A N D A N D S. W A L E S B R A N C H .
lenient towards antivaccinators, antisewerists, and antisanitarians, of all sorts and denominations, but I believe fully in the Nemesis which most surely overtakes everyone who breaks the sanitary code of nature, and I am sure that like many of the unpleasant and even venomous members of the animal kingdom, the faddists have their uses. What an unbearable set of people we should be if we had no opposition ! Perhaps even a worse fate might overtake us, and, tempted by theory into the garden of the Fairy Experiment, we might become engulfed in the vast chasm of imperfectly ascertained processes. It is, if I recollect rightly, Dr. Oliver Wendell Holmes who, in his " Autocrat of the Breakfast Table," describes every man as of a triple n a t u r e - the man as others see him, as he thinks himself to be, and as he really is. Perhaps I have tried to paint the Medical Officer as I think he ought to be. I am sure that in all work it is good to have an ideal, however difficult it may be to depict one. But if I cannot portray an ideal Medical Officer, I may permit myself a quotation upon Local Sanitary Administration as it should be : - - " Our Public Health Acts are but a mighty system of coercion designed chiefly to purge the body politic o f physical dirt and disorder, and the irremovable curses they entail. Urban and Rural Sanitary Authorities are the masters of the forces of life and death in one great section, and mete them out to poor sinners in their voyage through this world as _,~Eolus meted out the blasts he guarded, but with their caprice tempered by law. Each member of a Local Board is a trustee of the Public Health, and as he and his brethren discharge their vital functions they bring down upon the district the ~eward or the vengeance of that just and unerring nature which always pays in kind." " W i s e ratepayers will elect wise boards, and good boards will appoint good officials." To us is thus committed a great and important trust. Let us see that we are worthy of it, even in our hour of trial and opposition. One more word, more to the world at large than to our own limited audience. The Sanitary future of our country has already been shown to depend mainly upon the efficiency of the units who in their aggregate form the local bodies which govern us. From Local Boards and Town Councils to County Councils and Parish Councils the tendency is, day by day, more and more to place the Sanitary destinies ~f the Country in the hands of those least fitted to control them. The lesson which these men have to learn, and which it is our glorious but scantily remunerated lot to teach, is admirably set forth in the words of the anonymous writer from whom I have already quoted : "At this moment, judging by the unerring standard of the death rate, England stands at the head of civilization far above the shabby pretenders who conceal dirt below the glitter of finery. For what
is more barbarous than for a nation to sit with arms folded and see a large percentage of its people cut off prematurely by the most infamous of all diseases, those engendered by their own violation of the laws of nature in the item of personal cleanliness. Evety art, every science, every grace of civilization must give the place o f honour to the art, the science and the grace of a cleanly life, fulfilling its natural span unstinted by malaria and zymotics. E n g l a n d with all her faults is facile princeps in the sanitary race. So must she flourish ! " As I cannot expect agreement from everybody with my views, and as a presidential address admits of no debate, I will bid you good-bye in the words of Horace : Farewell : if you c a n m e n d these p r e c e p t s , d o : If not, w h a t serves for me m a y serve for y o u .
Conbtg'lon. At the conclusion of the address the president presented a report from the council of the branch dealing with the necessity for fixity of tenure for medical officers of health. Dr. Boobbyer moved, and Dr. Tew seconded, the following resolution: " That it is no longer desirable in the interest of the public health that medical officers of health be appointed for limited periods, and that every effort be made to obtain an amendment of the law in this particular. " That copies of this resolution be sent to the London Council, and to every branch of t h e Society." The resolution was supported by Drs. May and Barwise, and carried unanimously. The following new Fellow was proposed : John Biggam, M.D. Edin., M.O.H. Sedgley. The members subsequently dined together at the Grand Hotel. INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH,WEST OF ENGLAND AND SOUTH WALES BRANCH. ANNUAL MEETING, THURSDAY~ I I T H OCTOBERj I894.
ON the above date the Annual Meeting of the branch was held in the board room of the Royal Mineral Water Hospital, Bath. P r e s e n t : - - D r s . D. S. Davies,Walford, "Dowson, Blaxall, Alford, Brabazon, Harper, Stockwell, and Heaven, and Mr. J. Wallis Stoddart. A letter from the Secretary of the parent society was read, asking that the subject of " M e d i c a l Practice by Unqualified Practitioners in its Relation to Public H e a l t h " should be considered by the branch and the result communicated. The Secretary called attention to a previous resolution of the branch on the same subject, and after some discusssion the following resolution was proposed by Dr. Brabazon~ seconded by Dr. Dowson, and carried, viz. : " T h a t this branch is of opinion that it would be advantageous to the interests of the public health if Parliament would take steps to prevent the evil
PRESIDENTIAL consequences arising from unqualified practice, and that the matter should be taken in hand by the Parliamentary Bills Committee of the British Medical Association." The Secretary was desired to send a copy of the resolution to the Secretary of the Parliamentary Bills Committee of the British Medical Association. A second letter from the Secretary of the parent society with reference to the nomination of Fellows and officers to serve on the Society's Council was received between the branch meetings, and could not be considered till it was too late to make any nominations. It was decided that it should be an instruction to the Secretary to ask for any nominations at the future July meetings of the branch. The Treasurer's account was next presented and audited, and his report read. The report stated that the branch expenses had been very s m a l l - ..~ I i s. i o d . - - t h e receipts had amounted to ~ 3 17 s. and that the year 1894- 5 was commenced with a balance of ,~5 9 s. 2{d., as against a balance of ,~--,C2i4s. o½d., at the beginning of I893- 4 . A large number of subscriptions was still outstanding, five being for the year 1892-3, and no less than 39 being those for the year just closed, making a total of 44 subscriptions amounting to ..~7 I4S., due to the branch for past years. It was hoped that the members would be satisfied with the balance in hand, and with the financial soundness of the branch. The account and report were accepted. T h e Secretary then presented his report, which was to the following effect : - " D u r i n g the past year the new members joining the branch have b e e n : Fellows 4, Members i, Associates i ; total, 6. The branch therefore consists of Fellows 4 ° , Members 3, Associates 7, Honorary Associates 4, making a total membership of 54- T h e branch will, I am sure, greatly regret the loss through death of one of its Fellows, Dr. George Wilson, Medical Officer of Health for Clutton, who was a regular attendant at the meetings till failing health forbade. There have been the usual three ordinary meetings, two being held at Bristol and one at Cardiff. Among the papers read at these meetings were one by Dr. Walford ( ' N o t e s on an Outbreak of Typhus F e v e r ' ) , one by Dr. Walter Dowson ( ' S o m e Points in the Natural History of Small-pox'), and one by M r . J. Wallis Stoddart ( ' W h a t is a Dangerous Potable Water'). These have all appeared in the Society's journal. Reports of branch proceedings have from time to time appeared in PUBLIC HEALTH. T h e branch has also made a representation to the Council of the parent society with respect to an alteration in the Articles of Association under the head ' M e m b e r s h i p , ' submitting that it is desirable to substitute for the words 'ordinary members who shall be medical men qualified for appointment as Medical Officers of H e a l t h ' the words 'ordinar'¢ members who shall be medical men holding a degree or diploma
ADDRESS.
51
in public health.' In my capacity as Secretary--to express the views of the b r a n c h - - I attended a meeting, in London, of a Sub-Committee appointed by the Council to consider certain matters with regard to the representation on the Council of unattached members, the reference of certain matters to the branches before action by the Council, the inclusion in the Fellowship of Army, Navy, and Colonial medical officers doing work of a similar nature to that of Medical Officers of Health, and the question of the payment of representatives attending Council meetings in London. The decision of the Council on the Sub-Committee's recommendations has appeared in the Journal. Numerous other matters of more or less. import have from time to time been considered, and resolutions passed thereon. I think it will be generally admitted that the branch has fulfilled its purposes by bringing forward interesting matters for discussion, and permitting free interchange of opinions between medical officers, who would otherwise, owing to distance from each other, fail to keep in touch." The report was accepted. The retiring Council then nominated the O ~ c e r s and Council for 1894-95 and the names were approved by the meeting as follows: OFFICERS. P r e s i d e n t - - D r . D. S. Davies, Bristol. President-elect--Dr. H. J. Alford, Taunton. Vice-President--Dr. E. Davies, Swansea. Hon. Treasurer and Secretary--Dr. John C. Heaven, Clifton.
COUNCIL. Dr. Bond, Gloucester ; Dr. Brabazon, Bath ; Dr. Harper, Batheaston ; Dr. Prichard, Cardiff; Dr. Partridge, Stroud. Dr. Walter Dowson, already a member of the branch, having become eligible for the Fellowship as an acting Medical Officer of Health, was proposed as a Fellow by Dr. D. S. Davies, seconded by Dr. Brabazon, and elected. PRESIDENTIAL ADDRESS. The President (Dr. D. S. Davies) upon taking the chair firstthanked the members of the branch for the honour conferred upon him in electing him to the post, and trusted the deliberations of the coming year would he no less pleasurable and profitable than those of the past session. H e then proceeded to touch on several points of interest to all engaged in practical health work. Tracing the growth of public interest in sanitary work, he showed how the initial difficulty of enforcing ideas of cleanliness in the public mind having been overcome, it was followed by a reaction of crudely specialised interest, resulting in the predominant popular notion that all sanitary, or as he preferred to call it public health work, was bound by the limitation of drains, or " s o m e t h i n g to do
$2
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with drains " ; a limitation interfering seriously with t h e progress of research and scientific study of disease. T h e helpful stimulus of public opinion was recognised, though the attitude of reproach for non-attainment of a high ideal, together with a lack o f sympathy for past endeavour, and of recognition o f secured improvement, too frequently assumed by self-constituted philanthropic bodies confing late into the field of work, was deplored as dispiriting and often actually obstructive to steady progress. Criticising the control of infectious disease by notification, the speaker feared it was in many cases far too perfunctory, and possibly this contributed in s o m e degree to the slipshod notions entertained by the public. T h e leaving of " s o m e disinfectants" at a cottage in answer to a scarlet fever notification could neither act preventively nor tend to enlighten public opinion. But are the officers to blame for not securing isolation with nowhither to remove cases ? O n the question of hospital accommodation, which should be sufficient in a m o u n t and quality for all districts, the speaker critisised the d e p e n d e n c e upon large urban centres of the fringing local boards and rural districts except under conditions of proved expediency and under equitable adjustment of expenses, and strongly advocated the unification 9 f county administrative work under the advice o f skilled county medical officers of health, whereby " i s o ] a t i o n , " with its full connotation of disinfection, quarantine observation, school control, and internotification between districts, would be uniformly secured. T h e need of and the importance of inter-notification from district to district was insisted upon, and its observed value during t h e ~893- 4 small.pox outbreak set forth. T h e collect i o n and distribution o f the notification returns by the Local G o v e r n m e n t Board showed the State's appreciation of the importance of the system o f inter-notification, which was also largely e m b o d i e d in the English regulations for dealing with shipborne cholera. T h e speaker expressed a guarded opinion as to the advantage likely to accrue to the p u b l i c health service from the establishment o f Parish Councils, and deprecated any lowering o f the qualification for service upon District Councils. It requires an education of some width to grasp the necessity of spending m o n e y for future and as yet hardly apparent benefits, and the work of those responsible for public health must go beyond the hand-to-mouth methods of labour representatives. T h e control of the County Council must in the end be relied upon to conduct, under skilled medical advice, the labours o f Parish and District Councils to useful ends. Dealing with the subject of pensions to municipal officers, the President trusted a workable scheme would soon be forthcoming by which these trusted and useful servants of the public might benefit in th~ evening of their life.
A N D S. W A L E S B R A N C H .
A vote of thanks to the President for his address was p r o p o s e d by Dr. Brabazon, s e c o n d e d by Dr. Alford, and carried unanimously. WHAT
IS
A DANGEROUS POTABLE WATER ?
T h e discussion on Mr. Stoddart's paper, " W h a t is a Dangerous Potable W a t e r ? " followed : m Dr. Heaven stated that he agreed generally with Mr. Stoddart's criticisms on the report of the Royal Commission on the Metropolitan Water Supply, as he failed to see that all their conclusions were justified by the evidence. He called attention to some ot the important points in the paper, and especially took exception to the idea ot the Commissioners Ibat dilution of infective matter ensured safety. He was of opinion that neither chemical analysis nor inspection of surroundings should be in itself relied on as showing the the probable safety or not of a water, but that both means should always be employed. Dr. Alford agreed with the criticism on the Commissioners. He regarded chemical analysis as the best test of safety~ but expressed strongly the opinion that it ]s important to know the surrounding conditions before giving an opinion on any sample. He endorsed Mr. Stoddart's views as expressed in the paper, and accepted his definition of a potable water. Dr. Blaxall was of opinion that in judging of the safety of any water it is absolutely necessary to consider the nature of the gathering ground, for if that were polluted it would sooner or later cause disease. He considered analysis a valuable test, but it would not always decide on safety or danger of a water. He was of opinion that dilution cannot be relied upon to obviate danger, and that this view could not be too strongly impressed on all concerned. Dr. Walford said he agreed generally with Mr. Stoddart's conclusions, but could not quite agree with his view as to sand filtration--be had understood that Altona escaped cholera on account of the water being filtered, and suffered when filtration broke dowm Efficient filtration appeared to him to be a safeguard. Drs. Brabazon and Dowson also took part in the discussion. Mr. Stoddart, in reply, after referring to the favourable reception accorded to the paper, remarked that the only po!nt upon which there appeared to be any real difference of opinion, was the relative usefulness of the means available for determining the character of a water. Whilst admitting without reserve that every circumstance that can throw light upon the possible pollution of a supply should be taken into consideration ; still it was necessary to recogalse that comparatively few sources of water are, or can be, absolutely beyond reach of all contamination, especially in the case of private houses, and the speaker still adhered to the opinion that of all means at our disposal of ascertaining whether a given well water was affected by insanitary surroundings, none approached an intelligent consideratio*~ of analytical details. To this end a knowledge of the normal water of the locality was a great assistance, if not an essential ; wherein lay the advantage of the local analyst, and Mr. Stoddart deplored, with Dr. Alford, the tendency of interested persons to withhold information as to the source of samples, and even to furnish details that were known to be incorrect. Further, it was perfectIy obvious that the value of analysis was largely dependent upon its proper application, that the examination should be repeated sufficiently often to cover such alterations as must result from time to time from increase of pollution, etc., and especially that all.public water supplies should be kept under constant superwslon. With reference to the observation recorded in the paper (page 365, col. 2) the speaker was glad of the opportunity of pomuag out an omission which materially obscures the significanee of the experiment. Paragraph 7 should conclude, " and . . A at. Ioo c. . both received, etc. " T he objec ' t after stenhsmg of the experiment was of course to contrast the behaviour of the typhoid bacillus in sterilised and unsterilised water
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respectively ; and the earlier disappearance of the bacilli from the latter was attributed to the more tenacious character of the deposit of organisms owing to the presence of water bacteria and not to any destruction of them by antagonistic forms. With reference to the suggestion by Dr. Walford that the speaker under-estimated the value of sand filtration, it was pointed out that the very instance so largely relied upon as evidence of the protection afforded by the process, viz., the difference in incidence of cholera in Hamburg and Altona, furnished also a proof of the danger lurking in the occasional derangement, probably inevitable in filters on so large a scale. The mention, by Dr. Dowson, of the possibility of mistaking other products of human activity for sewage in a water, suggested many points of considerable theoretical interest, but scarcely affected the main issue, i.e., the character of the water as a potable supply. After a vote of thanks to Mr. Stoddart the meeting terminated. PROCEEDINGS OF THE NORTH-WESTERN BRANCH OF THE SOCIETY OF MEDICAL OFFICERS OF HEALTH. THE ordinary monthly meeting of this Branch was held in the rooms of the Chemical Society, Manchester, on Friday, October i2th, at 4 p.m. T h e following members were present: Drs. Anderson (President), Adams, Armitage, Deans, Edlin, Graham, Hannah, Jordan, Kenyon, Niven, Paget, Park, Porter, Sergeant, Stepheuson, Wheatley, and Vacher. The minutes of the last meeting were read and confirmed. Dr. Anderson proposed, and Dr. Vacher seconded, a vote of thanks to Dr. Niven for the trouble he had taken in showing the members of the Branch over the model artizans' dwellings in Oldham Road. A letter was read from the Hon. Secs. of the Central Society, on the question o f unqualified practice. T h e Branch having previously discussed this matter, simply confirmed the resolution passed at the July meeting. A letter was read from the Chairman of the Lytham Ratepayers' Association in answer to an enquiry as to what had been done with regard to the appointment of a Medical Officer of Health for Lytham. A letter was also read from Dr. Eason thanking the Branch for the interest they had taken in this matter. Dr. F. Booth, M . O . H . for St. Ann's-on-Sea: Dr. A. F. Keyworth, M.O.H. for Marple; and Dr. H. P. Smeeth, M . O . H . for Brinnington, who were nominated at the last meeting, were duly elected members. T h e following nominations were r e a d : W. Hodgson, L.R.C.P., L.F.P.F.G., proposed by Dr. Sergeant and seconded by Dr. P a g e t ; M r . T. de Courcy Meade, proposed by Dr. Porter and seconded by Dr. Niven. T h e President then introduced the subject of the relation of this Branch to the Central Society with special reference to the alteration i n paymen, of subscriptions which had been made. After some discussion, the following resolution was proposed by Dr. Paget, seconded by Dr. Niven, and carried : " T h a t this Branch emphatically protests
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against the arrangement having been made with. regard to the annual subscriptions without t h e Branch having been consulted, and desires to know if the regular liabilities of the Branch will always be discharged by the Central Society." ~cTEST FOR NITRITES AND NITRATES IN POTABLE ~,VATER. '~ Dr. Kenyon demonstrated the test for nitrates and nitrites in potable waters, described by Mr. George Harrows in the " J o u r n a l " o f the Chemical Society, for t 8 9 i , page 32o, with which should be read a paragraph in one of the volumes for r892 , page 657. T h e reagent can be kept, without any trouble, for months unimpaired, and its delicacy is such that it can be used for quantitative deferral. nations, and will easily show "02 parts of nitrogen, in ioo,ooo parts of water. T h e formula is : naphthal. amine, one gramme ; sulphanilic acid, one gramme; ordinary strong hydrochloric acid, 25 cubic centimetres ; boil with 20o c.c. of distilled water until dissolved, adding animal charcoal to decolourise if necessary, fill up to 500 c.c. Ten c.c. of this solution. is added to 50 c.e. of the water to be examined in a small beaker. A very small amount of zinc dust 0"007 gr. is added, the liberated hydrogen reduces nitrates to nitrites, and a crimson colour is pro~, duced. If nitrites are present the colour appears at once, without adding zinc; heat should be applied after twenty minutes or so, and the contents of the beaker brought to the boiling point to get the full tint, which is otherwise partly lost through precipitation by earthy salts present. For t h e purpose of comparison, a standard solution is m a d e by dissolving "72I gramme of nitrate of potash in a litre of water, equal to o ' i part of nitrogen in i,ooo. This is diluted with water to equal i ' o , o'i, o'o~ parts per roo,ooo as required. Dr. Graham then read a paper on " S m a l l Pox Problems."
SIvIALL-POX PROBLEMS. By WILLIAM GRAHAM, M.D., M.O.H. Middle,on. During nineteen years' experience of Middleton~ and its neighbourhood as a general medical practitioner, I have found until recent!y small-pox a very rare disease. I n 188i, shortly after I became Medical Officer of Health for the district, a few cases occurred, but it did not spread to any extent, and no case was notified from incorporation of the borough in 1886, until the 3rd November, 1892 , although a compulsory order was in force from August, I889. The first patient received the contagion, almost beyond a doubt, from the vicinity of Westhulme Hospital, Oldham. She was treated at home, but great precautions were taken to prevent a spread, although a child, aged three years, to whom this patient was aunt, became affected, and was removed to Westhulme Hospital, in the vicinity of which the child had resided with the parents.